University of Twente Student Theses


Use of Home Medication during Hospital Admission An Effect and Process Evaluation

Aalderink, L. (2018) Use of Home Medication during Hospital Admission An Effect and Process Evaluation.

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Abstract:Introduction: The Institute of Medicine has released a report named Crossing the Quality Chasm, which provides a plan that classifies and unifies the components of healthcare quality by stipulating six elements for improvement: safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability. The aims of these topics (patient safety, increasing healthcare costs, the waste of medication, and the upcoming trend of shared decision-making) are reasons to implement the innovation “Use of Home Medication during Hospital Admission” (UHDH). The objective of the effect evaluation is to determine whether UHDH has an effect on medication adherence and patient satisfaction. The objective of the second study is to identify the determinants that affect the implementation process of UHDH using data from two different departments, the Internal Medicine (Hematology) and the Neurology departments, in order to improve medication safety, efficiency, patient centeredness, and consequently the overall healthcare quality. Methods: To measure whether the innovation influenced medication adherence and patient satisfaction with medication use, a questionnaire was developed. Determinants found in the literature led to an (online) questionnaire for the process evaluation that was filled in by 56 respondents, in order to determine the facilitating and impeding factors of the implementation process of UHDH according to the stakeholders. Results: No significant differences were observed for the medication adherence and patient satisfaction. However, slight differences were observed in terms of adherence between the pretest and posttest. A small trend was noticed for all the mean scores of patient satisfaction in this study, as these were higher in the pretest. The process evaluation revealed that the most impeding determinants and significant differences were found in the organization category of determinants for both the Internal Medicine (Hematology) and Neurology departments. For both departments, the most facilitating factors were found in the healthcare professional category. Conclusion: The effect evaluation shows that the level of both medication adherence and patient satisfaction with medication use is very high in both the pretest and posttest. This ceiling effect could be an important factor explaining why only a slight increase in adherence and patient satisfaction was observed. The process evaluation shows that an innovation, such as the UHDH, requires a well prepared organization, which was not the case here. Implementing such an innovation while an organization is undergoing restructuring and other implementations are executed simultaneously is not advisable. To execute this implementation differently in the future, recommendations are provided.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences MSc (66851)
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