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Towards interprofessional medication safety risk management: a qualitative interview study for physicians in primary and secondary care

Por: Saavalainen · A. · Sirenius · H. · Linden-Lahti · C. · Laukkanen · E. · Hosia · H. · Holmström · A.-R.
Objectives

Investigate interprofessional medication safety risk management from the perspective of physicians in healthcare settings.

Design

Qualitative, semistructured interview study. Data analysed with an inductive content analysis.

Setting

Wellbeing Services County in Central Finland.

Participants

17 physicians working in different healthcare settings or specialties.

Results

Physicians’ overall perception of interprofessional medication safety risk management was generally positive. They considered their own responsibility for medication safety as both comprehensive, encompassing the safety of the entire unit and limited, focused primarily on prescribing the correct medication. Organisational barriers to participating in medication safety promotion comprised insufficient healthcare resources and unclear distribution of tasks and responsibilities. Personal barriers included prioritisation of clinical work, considering medication safety as an administrative task and experiencing the process to be slow and complex. Strong leadership, increased visibility of medication safety, framing the topic positively, targeted education and fostering physicians’ intrinsic motivation were identified as means to increase physicians’ participation in medication safety risk management.

Conclusions

This study emphasises the importance of integrating physicians into interprofessional, systems-based medication safety risk management as a core element of high-quality care. Despite recognising their broad role, physicians face barriers such as organisational constraints and limited identification with medication safety advocacy. Addressing these challenges requires enhancing their understanding of the medication management and use process and fostering shared responsibility through time allocation and interprofessional leadership structures.

Evaluating the impact of the Medicaid Balancing Incentive Programme on long-term care utilisation by living arrangement: a quasi-experimental study

Por: Lee · A.-R. · Yang · Y. · Rapp · T. · Torres · J.
Objectives

To evaluate the impact of the Medicaid Balancing Incentive Programme (BIP) on long-term services and supports utilisation among older adults, focusing on differences in living arrangements.

Design

Quasi-experimental study using a generalised difference-in-differences approach.

Setting

States that participated and completed BIP (treatment group: 18 states) and states that were eligible but did not participate (control group: 17 states).

Participants

Older Medicaid beneficiaries from the Health and Retirement Study (2006–2018) across states that participated in BIP and those that did not. A negative control analysis was conducted using non-Medicaid beneficiaries.

Outcomes

We examined the probability of long-term nursing home stays (over 100 days), professional home healthcare and three types of home care services for activities of daily living: paid professional caregiving, paid informal caregiving and unpaid informal caregiving. Analysis was stratified by living arrangement (living alone vs with others).

Results

BIP participation was associated with a 5 percentage point (pp) decrease in long-term nursing home stays among Medicaid beneficiaries living alone (average treatment effect on the treated, ATT=–0.06, 95% CI –0.10 to –0.02; p

Conclusions

BIP contributed to a reduction in institutionalisation for individuals living alone while increasing support for family caregivers in multiperson households. These findings highlight the importance of tailoring long-term care policies to the specific needs of populations based on their living arrangements.

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