Sharing of relevant medication information through discharge summaries in an acute setting – perspectives from hospital-based physicians, general practitioners and clinical pharmacists

Sharing of relevant medication information through discharge summaries in an acute setting – perspectives from hospital-based physicians, general practitioners and clinical pharmacists | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sharing of relevant medication information through discharge summaries in an acute setting – perspectives from hospital-based physicians, general practitioners and clinical pharmacists Joo Hanne Poulsen Revell, Nathalie Fogh Rasmussen, Maja Schlünsen, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5758268/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Poor-quality discharge summaries, particularly regarding medication information, can lead to adverse drug events, readmissions or even to death. Therefore, effective medication communication across sectors is crucial, especially for multimorbid elderly patients, who are at high risk due to polypharmacy and complex needs. While pharmacists’ recommendations improve discharge quality, they also add to the information flow. This focus group interview study aims to explore healthcare professionals’ perceptions of the current exchange of medication information in discharge summaries between an emergency hospital department and general practice to tailor the communication of recommendations from a clinical pharmacist after a medication review ensuring a safer transition between healthcare sectors for patients in Denmark. Methods A semi-structured focus group interview was conducted with nine healthcare professionals from primary and secondary healthcare sector. Data were synthesized independently by two researchers using thematic analysis. Results In total, the focus group interview included nine participants (four hospital-based physicians (including a clinical pharmacologist), three general practitioners (GPs), and two clinical pharmacists). We identified three themes each including three sub-themes from the thematic analysis: Theme 1) Challenges with the usability and implementability of medication content in discharge summaries with sub-themes concentrated on key information, lack of information and usability of updated medication lists. Theme 2) Different healthcare practices affect the management of medication information from discharge summaries in which the sub-themes were concentrated on time constraints, color coding interpretation and information load, and theme 3) How to tailor pharmacist-led recommendations from medication reviews focusing on information regarding polypharmacy and medication compliance, evidence-based information and information directed to the outpatient clinics. Conclusion This study highlights new knowledge crucial for tailoring the communication of recommendations from a clinical pharmacist: there is a need for concise medication information in discharge summaries focused on medication changes, reasons for these changes, polypharmacy, compliance and recommendations requiring GP review. Improving discharge summaries requires standardized routines, shared format understanding, and innovative technology to ensure that GPs can easily find, comprehend, and act on medication information. Moreover, exchange of medication information for outpatients were perceived challenging and needs further exploration. Figures Figure 1 Figure 2 Background Poor-quality discharge summaries, especially when it comes to medication information, can lead to adverse outcomes, such as adverse drug events, readmissions to hospital, or even death, due to e.g. medication errors or lack of medication information ( 1 – 9 ). Therefore, effective discharge communication and coordination between healthcare professionals across sectors in relation to patients’ medication become important for the prevention of adverse outcomes in the transition of patients ( 1 , 2 , 10 ). However, discharge communication becomes especially challenging in the care of multimorbid elderly patients as they often have complex needs, use multiple medications, and are at high risk of experiencing adverse drug events and interactions ( 11 – 13 ). Thus, the quality of the medication information provided in discharge summaries play a significant role in patient transition across healthcare sectors. It is common practice across countries to include recommendations to the general practitioner (GP) in the discharge summaries when patients are discharged from hospital. During follow-up by the patient’s GP, information flow is crucial, but challenging due to the massive amount of data registered for each patient at the hospital combined with a GP’s lack of time to review the hospital discharge summaries. Since 2019, Danish hospital-based physicians have been obliged to highlight within the discharge summary whether there is a recommendation for GP follow up that consists of a brief and precise statement of the suggested action in a recommendation text box ( 14 – 16 ). The purpose of the highlight is to ensure that only necessary information is included to generate a more focused discharge summary ( 14 , 16 ). In addition to a more focused information flow, reduction of medication discrepancies, adverse drug events and general patient outcomes has been associated with including clinical pharmacists’ recommendations in the discharge process ( 17 – 24 ). One Danish study described that 25% of all emergency department patients were identified by clinical pharmacists to have medication issues, of which 47% were considered to be serious ( 25 ). Introducing clinical pharmacist recommendations to a discharge summary could simply contribute additional information to an already overloaded information flow across healthcare sectors. However, recommendations about medication issues are vital to ensure GPs can take the appropriate action. Therefore, the aim of this study was to explore healthcare professionals’ perceptions of the exchange of medication information in discharge summaries between an emergency hospital department and general practice to tailor the communication of recommendations from a clinical pharmacist after a medication review ensuring a safer transition between healthcare sectors for the patient in a Danish setting. Method Study design This qualitative focus group interview (FGI) study was conducted in April 2024 and adheres to the Consolidated Criteria for Reporting Qualitative Research recommendations (COREQ, supplementary file 1) ( 26 ). FGI was chosen as a method to obtain in-depth knowledge about the perspectives on the exchange of medication information in discharge summaries. FGIs are facilitated group discussions, where open-ended questions are asked in interactive group settings, where participants can interact with other group members ( 27 , 28 ). An experienced facilitator led the FGI, and one junior researcher was present as an observer. The interview took place in a meeting room at the University Hospital of Southern Denmark in Aabenraa (SHS). Setting The Danish health care system is currently organized into three administrative levels: the national level (State), the regional level (5 Regions), and the local level (98 Municipalities). The state holds the overall regulatory and supervisory functions in health and elderly care. The five regions are primarily responsible for the hospitals, the general practitioners (GPs) and for psychiatric care. The 98 municipalities are responsible for a number of primary healthcare services as well as for elderly care. GPs practice privately and work according to a collective agreement, subject to periodic renegotiations between the government and the physicians’ union. Remuneration is based on a combination of capitation (based on patient lists) and fee-for-service ( 29 , 30 ). The emergency department (FAM) at SHS comprises 42 patient beds and an average patient flow of 120 patients per day from a catchment area of approximately 225,000 inhabitants. During the day, there are regular rounds by the hospital-based physician in charge of each patient's care, where a diagnosis is given and treatment planned. Short-stay patients will be discharged to home and eventually followed up by a GP in one of the 80 general practice clinics in the catchment area of SHS. Currently, a pharmacy technician (pharmaconomist) is present eight hours a day at FAM and conducts medication history and reconciles patients’ medication. In a potentially new service consisting of pharmacist-led medication reviews for elderly polypharmacy patients at FAM, the pharmacists would reconsile and review the patients’ medication and preferably validate it with a patient interview. The pharmacist’s medical recommendations would be included in the written discharge summary. The discussion in the FGI was based on this premise. In Denmark, all discharge summaries, where follow-up is deemed necessary, are color-coded by the hospital-based physician according to urgency. The color code is displayed at the top of the summary if follow-up by the GP is needed (Fig. 1 ). Recruitment of participants Purposive sampling was used to assemble focus group participants from hospitals and general practice. The purposive sampling allowed the researchers to select individuals, who represented the demographics of healthcare professionals within the catchment area of SHS in terms of practice area, age, gender, and years of practice experience ( 28 ). The hospital management at FAM and at the hospital pharmacy assisted in the recruitment of hospital-based physicians and pharmacists, respectively. The GP participants were identified through the GP coordinators’ network, which represent all GP practices in the local area. Letters of invitation to participate in the focus group were sent via e-mail and those interested contacted the researcher or the GP coordinator. GPs of all grades were eligible to take part in the focus group. Data collection A semi-structured interview guide (supplementary file 2) was developed based on previous experience with pharmacist-led recommendations conveyed through discharge summaries and the literature ( 6 , 13 , 27 , 28 , 31 ). Analysis A reflexive thematic analysis was used to identify key themes ( 32 ). The coding and the development of themes include familiarization with the data by reading the transcripts multiple times, generating initial codes, searching for themes, reviewing themes, and defining and naming themes ( 32 ). Two authors (JHPR and MS) performed the coding individually and any discrepancies was discussed. The first author (JHPR) combined the codes into sub-themes and overall themes using the qualitative data analysis software Nvivo. Ethics This study is part of a RCT where approval is granted from clinicaltrails.gov (Clinical Trial Number: NCT06451692 – Date: 11-06-2024), together with the approval to store data in accordance to regional policy (24/12239). As data will not contain identification of participants, and the study is not a biomedical study, approval from the National Ethic Committee was not required. Written information was provided to group participants about the purpose of the focus group and their involvement. Informed consent was obtained from each member, before conducting the FGI indicating willingness to participate, agreement for the FGI to be audio and video recorded, and potential publication of study results in an anonymized form. The FGI was audio recorded and transcribed verbatim. Results One FGI was held with nine participants and went for approximately 150 minutes. The focus group consisted of four hospital-based physicians (including a clinical pharmacologist), three general practitioners, and two clinical pharmacists. The hospital-based physicians were specialized in acute medicine and pharmacology, the clinical pharmacists provided clinical ward-based pharmacy services to SHS, and the GPs each represented different sizes of practice partnerships. The participants’ experience levels varied from early career to experienced physicians, pharmacists and GPs and some participants in the FGI were known to each other. In the following analysis and discussion, the participants are numbered according to their focus group representations (Hospital-based physician 1–4, GP 1–3, and Pharmacist 1–2). The thematic analysis revealed three main themes: 1) Challenges with the usability and implementability of medication content in discharge summaries, 2) Different healthcare practices affect the management of medication information from discharge summaries, and 3) How to tailor pharmacist-led recommendations from medication reviews. These main themes each hold three sub-themes. In the following, the themes are represented by selected quotes from participants, independent of the number of participants mentioning them. An overview of the main themes and sub-themes is presented in Fig. 2 . Theme 1: Challenges with the usability and implementability of medication content in discharge summaries Sub-theme 1.1: Discharge summaries should include key information and straight-to-the-point information All participants found the exchange of medication information through discharge summaries between hospital and general practice essential. However, the GPs stated the importance of receiving overall information about potential medication changes and the course of action during admission, together with a follow-up plan after discharge. “For me, in practice, it’s important to know why the person has come in, what has been done – not in any detail... and most importantly, what the plan is. Should there be follow-up, or shouldn’t there be follow-up [in general practice]” [GP 1] “Well, I think it’s helpful, at least, if medication changes have been made, that it’s clear what the reasons are – that its written why a change has been made” [Hospital-based physician 1] Based on previous experience of very long discharge summaries, the GPs prefer the information to be short and to the point to ensure user-friendliness is increased in general practice. “I think the ‘best’ example is like a six or seven-page report to do with shortness of breath – you lose track of the information, and the patient arrives and still has shortness of breath, and you’re still not quite sure what’s actually happened and what the plan really is. No one has an overview. So, the best thing would be three lines about ‘this happened, so the plan is that, and maybe to clearly mark it red, yellow, or green. Then I’d be satisfied” [GP 1] Sub-theme 1.2: Hospital-based physicians lack information about the rationale with specific medication treatments In addition, the hospital-based physicians agreed that they lacked information about the rationale behind the prescribed medications from the GPs perspective. However, a high patient flow and unfamiliarity with the rationale behind specific medication treatments may explain why hospital physicians are not always able to provide detailed medication information needed by GPs. “And we [hospital doctors] often discuss this – we wonder, why a patient is on prednisolone, or why they are on two antidepressants, and now they’ve been admitted with a little hyponatraemia, and that’s just wrong– Write it down! I mean, give it back to you [GPs], because there might be reasons we can’t figure out, so if it’s not critical where we need to pause or discontinue it [medication], then write it to you... But we don’t do that very often because things move very quickly” [Hospital-based physician 2] “Everyone thinks patients take too much medication... But we just don’t have the time to look closely into it” [Hospital-based physician 3] Sub-theme 1.3: Challenges with the usability of the updated medication list in practice Although, an updated medication list is a standard part of the discharge summary, the medication information is not always approved and available to the hospital-based medical secretary. Thus, an up-to-date medication list does not appear in the discharge summary, preventing discharge summaries reaching an expected standard. “…the medication list wasn’t always available, even though she [hospital-based medical secretary] wrote the discharge summary… and then they discharge them [the patients] without it, so therefore you sometimes receive them [discharge summaries] without the medication list” [Pharmacist 2] In addition, the usefulness of receiving the updated medication list after discharge varied between GPs. “I think it’s actually helpful when a discharge summary includes information about the medication they’re prescribed” [GP 3] “I almost exclusively use the Shared Medication Card” [GP 2] “Well, the full list, I don’t really… I don’t think I’ve actually used it, to be honest, the one that’s in the discharge summary” [GP 1] Theme 2: Different healthcare practices affect the management of medication information from discharge summaries Sub-theme 2.1: The discharge summaries are not always read by the GPs The practical management of incoming discharge summaries and the time frame for reading and acting on them, vary among GPs. “Some GP practices have simply decided not to read the discharge summaries. (…) because we just don’t have the resources to wade through everything. (…) discharge summaries can sit there and only get read after a week or so” [GP 3] “In regards to trying to read discharge summaries, we have a person to manage the post and distribute them to the specific GP who knows the patient, and then it’s the GP’s responsibility to follow it up” [GP 2] Sub-theme 2.2: The color coding is interpreted differently among healthcare professionals Further, the participants discussed the color-coding of the discharge summaries in terms of the urgency for GPs to act and the interpretation and understanding varied among participants. “I think we’ve come much closer to something that works well, like ‘red-yellow-green’ … I also think many people now have an understanding of what it actually means for the recipient. I mean, what it means when a red, yellow, or green discharge summary is issued. I still think there are many who maybe struggle to understand the purpose of the system, and that’s why sometimes it still goes wrong” [GP 1] “We [pharmacists] have figured out how to use them now, so we often issue yellow marking[in the discharge summary] because we think it’s something the doctors should respond to” [Pharmacist 1] “…it [yellow discharge summary] also implies that the patients don’t have a relative who can make contact for them, or a career, or something like that… So actually, very few people need a yellow discharge summary. There’s also an element of personal responsibility in it. I mean, it’s not like… in that sense, the doctor isn’t a support worker” [Hospital-based physician 1] Sub-theme 2.3: Hospital-based physicians are not always aware of the information load in a general practice Further, GPs receive an extensive number of discharge summaries daily, which was a new revelation to the hospital-based physicians, who acknowledged the importance of sharing this information with other hospital-based physicians. “We have the equivalent of around 5,000 patients, and we probably receive… well, just under 100 discharge summaries every day. So, if we’re supposed to read through them and grasp the meaningful parts… we can’t sit there and act on it all. Discharge summaries are information for us. If there’s something we need to do, it’s really hard to grasp it in the endless stream of incoming things” [GP 3] “I think the point about receiving 100 discharge summaries a day was really helpful information for me, and it’s the sort of thing we can communicate to our junior doctors, so they’re aware of it” [Hospital-based physician 3] Theme 3: How to tailor pharmacist-led recommendations from medication reviews Sub-theme 3.1: Information on medication compliance and polypharmacy should be included and be kept short, simple and summative and placed at the top of the discharge summary Various views on relevant medication-related content from a pharmacist-led medication review, such as compliance issues, patient attitudes towards medicine, and polypharmacy were discussed among participants. “I do think it’s good to know if I’ve started something, and the patient hasn’t picked up the medication or hasn’t started taking it” [GP 1] “…we’ve done quite a bit of detective work, talking to the patient and looking at what preceded this [medication before admission]... Also talking to the patients about what they want… what medications they like taking, what they don’t like, what they prefer, and what their motivation is for taking medicine, and how their compliance is.” [Pharmacist 1] “I think it’s the polypharmacy... I mean, getting it sorted out, because it’s a really big burden for patients to have to take all that [many medications], even though it probably doesn’t make any difference. It’s a big burden for them... And yes, the anticholinergic burden is also something we probably overlook quite a lot in the hospital” [Hospital-based physician 2] Concerning the sharing of the pharmacists recommendations regarding medicine in the discharge summaries, all participants agreed that the format should be kept short, simple, and summative. “In reality, the discharge summary should be concise enough to serve as a conclusion to everything else… That means a red, yellow, green summary of maximum of three, four, maybe five lines, briefly stating what medication changes have been made and the reasons for them, along with the pharmacist’s recommendations, if there’s been one involved with ‘be aware of this and that” [GP 1] “It should just be the pharmacist’s suggestions: 1, 2, 3, in order of priority… then you [the responsible physician] can consider whether or not you agree” [Hospital-based physician 3] In response to the question of where they would prefer the pharmacist’s recommendations to be placed in the discharge summary, there was agreement among all participants that it should be included under the conclusion at the top: “It just needs to be included under the conclusion, because that's what we read” [GP 2] “Yes, exactly. That’s what will appear at the top—in some systems, at least” [Hospital-based physician 1] Sub-theme 3.2: Pharmacists’ recommendations should be kept evidence-based Some hospital-based physicians and GPs had previously collaborated with clinical pharmacists, describing the pharmacist-led medication reviews as highly educational. “… there’s also a lot of learning from these medication reviews. I remember from geriatrics… ‘Pantoprazole, ulcer for four weeks, now they’ve been on it for three years – is it really indicated, question mark’… So, there’s really valuable learning for us [doctors], and you get really good at reviewing things like pantoprazole and aspirin, and all those medications that should be stopped or reassessed at some point” [Hospital-based physician 2] “I know that at one point it was pharmacists who did these pharmacy rounds and made recommendations like ‘be aware of this’, ‘maybe you should consider changing this’. These are the kinds of things I’d actually like to see, especially if someone’s been hospitalised for a long time and there may have been five recommendations from a pharmacist that haven’t been implemented for some reason. And really, it’s probably something that should be part of our domain, not so much the hospital’s, because we have the long-term relationship with the patient. It would be interesting to get that included in the discharge summary – the pharmacist’s recommendations” [GP 1] In addition, all participants agreed that pharmacists should contribute with their professional knowledge about medicine, and potential pharmacist-led recommendations should be kept evidence-based. “As I remember your medication reviews, they were very objective and evidence-based… Dual antiplatelet therapy, 12 months after PCI, and now it’s been 3 years. So, it’s up to the doctor to decide… But you kept it completely objective, and it was evidence-based… And that’s always evolving, the guidelines, and you’re astute about that” [Hospital-based physician 2] “It can be a bit difficult to be aware of certain things [medical issues]… if the doctor doesn’t know what to be aware of. This is where your professionalism as pharmacists really comes in. Because it’s about the combination and the whole person… The primary focus is on the medications, so it’s important to contribute your expertise” [Hospital-based physician 4] “You’re allowed to be a bit tough on some of the recommendations. For instance, alendronate prescribed for 15 years – cancel it” [GP 1] Sub-theme 3.3: Recommendations related to outpatients’ medication should be directed to the outpatient clinics The GPs found it challenging to maintain an overview of a patient’s medication when they were followed at outpatient clinic(s). Thus, potential pharmacist-led medical recommendations should be directed to the outpatient clinics instead of the GP. “Those [patients] we have for ourselves [in general practice] are much easier because we have a full overview, but the issue is being aware if they attend different outpatient clinics, then there is some medication they’re receiving there – we’re not really involved in that. And it also means that if you [the pharmacist]come with some recommendations, you need to keep in mind that if it’s that medication, then it’s actually that outpatient clinic you should be talking to, not the GP… Ideally, we [GPs] shouldn’t interfere with what they’re doing in the outpatient clinic… I think it’s a huge problem” [GP 3] “… it would be good if your correspondence [pharmacist recommendations] were sent to the outpatient clinic. For example: We’ve done a medication review, we think this is a little odd and therefore suggest X,. I also think some of the medications prescribed from some outpatient clinics as ridiculous, and of course, it’s not the GP who has the authority” [Hospital-based physician 3] Discussion In this study, we found that concise and precise information is paramount for the GPs who receive and act on the provided information in discharge summaries. We identified three main themes from the thematic analysis of the focus group interview: Theme 1) Challenges with the usability and implementability of medication content in discharge summaries described the three sub-themes indicating that discharge summaries should include key information and to-the-point information, hospital-based physicians lack information about the rationale with specific medication treatments, and that there are different views on the usability of the updated medication list in practice. Theme 2) Different healthcare practices affect the management of medication information from discharge summaries depicted three major challenges as described in the sub-themes including that the discharge summaries are not always read by the GPs, the color coding are interpreted differently among healthcare professionals, and the hospital-based physicians are not always aware of the information load in general practice. Theme 3) How to tailor pharmacist-led recommendations from medication reviews identified characteristics of relevant medication-related content from a pharmacist-led recommendation review to include in the discharge summaries, i.e. information on medication compliance and polypharmacy, and pharmacists’ recommendations should be placed at the top of the discharge summary, be evidence-based and if the recommendations are related to outpatients’ medication they should be directed to the outpatient clinics. Overall, the focus group participants agreed that including pharmacists’ recommendations in discharge summaries would increase the professional standard of discharge summaries. Thus, the results of this study contribute to understanding healthcare professionals’ perceived challenges and perspectives on the relevance of specific information in the exchange of medication information in discharge summaries between an emergency hospital department and general practice in a Danish setting. Our findings support previous research in other countries demonstrating a positive attitude towards pharmacist-led recommendations in discharge summaries as a resource in the care transition between secondary and primary healthcare ( 6 , 13 , 33 , 34 ). However, the FGI identified some challenges similar to other findings reported in the literature. For example, technical limitations result in non-updated or inaccessible medications lists ( 6 , 13 ), the high patient flow means that hospital-based physicians cannot always provide optimal medication information and GPs cannot prioritize sufficient time to review discharge summaries for all patients ( 13 ). The participants’ solutions were similar to those proposed in previous studies, i.e. auto-generation of medication changes and streamlining of patient color coding practice among the healthcare staff ( 6 , 13 ). In this study, the participants also referred to the conclusion placed at the top of the discharge summary, i.e. the obligatory recommendation text box ( 14 – 16 ), as the most important part of the summary. This indicates the need for very concise information as this part is often the only one the GPs read. The experience by GPs with the recommendation text box has also been described in a Danish nationwide survey study showing that the box is easy to find and provides brief and precise information about recommended follow-up ( 16 ). Working with a standard operating procedure has been described in a previous quality improvement project on acute medicine wards, where the implementation of a template for discharge summary completion significantly improved the content and quality of discharge summaries on the acute medical wards ( 35 ). None of the participants expressed concerns about the clinical pharmacists’ expertise or role. On the contrary, they characterized their expertise as being very ‘evidence-based’ and emphasized the importance of ensuring that pharmacists’ recommendations in discharge summaries are kept evidence-based. Mutual respect among the participants was observed in the discussion of views on relevant medication-related content from a pharmacist-led medication review. The GPs and hospital-based physicians were aware that the responsibility for follow-up was placed with the GPs and that the pharmacist's notes were meant as recommendations, not orders. Thus, they all agreed that the pharmacist’s recommendations should be written precisely and prioritized with no need for ‘empty words’ and polite phrases. These perceptions may be unique for the participants in this specific focus group or for the communication culture in the Danish healthcare system. However, other studies also reported similar positive views towards clinical pharmacists ( 34 , 36 , 37 ) although there were some exceptions ( 34 ). The complexities of discharge summaries for patients receiving outpatient care were also discussed. The GPs suggested the information that required outpatient follow-up should be directly handed over from the inpatient hospital department to the outpatient hospital clinic, and thus, the follow-up actions on outpatient care matters should not go through the GP. Contrary to this, the GPs in a US interview study of primary care physicians’ perspectives on high‑quality discharge summaries, suggested a specific section in the discharge summary to highlight and group follow-up items needed immediately after discharge, i.e. outpatient referrals which need to be placed by the primary care physician ( 38 ). Outpatient care in the US healthcare system is not directly comparable to outpatient care in a Danish setting, However, outpatient care in the US is often placed at independent outpatient clinics outside the jurisdiction of hospitals, whereas in Denmark, the outpatient clinics are part of the hospital. Strengths and limitations A major strength of using a qualitative method to study healthcare professionals’ perceptions of the current exchange of medication information in discharge summaries is the in-depth real-world information about participants’ perceptions and what has been experienced by each participant ( 39 ). Moreover, it strengthened the study that all participants answered relevantly and participated in the dialogue with the interviewer and the other informants, maintaining mutual respect for the various professions represented. However, bias may occur if the participants affect each other in a way that they do not speak their minds. In this study, the participation of GPs, hospital-based physicians, and clinical pharmacists together may have caused the participants to moderate their opinions to avoid offending one another. To overcome this bias, the interviewers offered opportunities to explore different opinions and experiences by asking open-ended questions and additional clarifying questions. Furthermore, the credibility of the study was strengthened for several reasons: 1) the research team consisted of members with diverse backgrounds in both research experience and academic fields, specifically within social pharmacy and clinical pharmacy and 2) two researchers carried out the process of meaning condensation independently and subsequently discussed potential discrepancies before the final themes were determined (investigator triangulation). A limitation of the study was the completion of only one focus group interview, thus, there was a risk of not achieving data saturation. However, we used an exploratory research design and did not expect data saturation ( 40 ). Moreover, a group size of nine participants allowed the inclusion of two or more representatives from each profession, but the study may have been strengthened further if younger, less experienced physicians had been represented as they may have contributed with alternative views. Lastly, this study included only healthcare professionals in the proximity of SHS in Aabenraa only, limiting the generalizability to other general practices and hospitals nationally and internationally. Implications for future practice and research During the interviews, the different professions gained valuable insights into each other's processes, highlighting areas for potential improvement. Thus, providing opportunities for communication and collaboration between GPs, hospital physicians and clinical pharmacists could further improve the healthcare professionals’ understanding of the rationale with specific medication treatments and thus improve discharge summaries’ content. More specifically, the results of this study indicated that information on medication should be summative and placed at the top of the discharge summary and focused on medication changes, reasons for these changes, polypharmacy, compliance and pharmacists’ recommendations on medications requiring GP review. In addition, to improve discharge summaries a unified understanding of the yellow color code is needed, as interpretations vary among GPs, hospital physicians, and pharmacists. Innovative solutions such as auto-generation of medication changes and technical improvements to prevent non-updated or inaccessible medications lists are also encouraged. GPs may perceive pharmacists' recommendations as adding to their workload, with a high patient flow and time constraints being a significant challenge ( 6 ) highlighted by the participating GPs in this study. Organizational factors in general practice might limit the capacity to allocate more time for these tasks. Further work is needed to balance the information provided whilst not contributing to information overload. Future research could explore whether GPs act on pharmacists' recommendations and their impact on patient outcomes, which would help validate the quality of these recommendations. Additionally, since many elderly patients with multiple chronic conditions receive care in various outpatient clinics, future intervention studies should test the effect of pharmacist recommendations in discharge summaries in supporting a safe transition for outpatients between primary and secondary care, ensuring critical information is preserved. Conclusion This FGI study enhances our understanding of which medication-related information in discharge summaries is most important for GPs. The study found that medication-related information in discharge summaries must be concise and to the point, and that pharmacist’s recommendations in discharge summaries are valued by GPs and hospital physicians. Most importantly for future practice, the study results revealed that to further improve discharge summaries, it is essential to establish standardized routines and a shared understanding of the elements in the existing format, and eventually, innovative technological solutions ensuring that the receiver of the information is able to easily find, understand, and act upon the information. Moreover, exchange of medication information for outpatients needs to be evaluated further. Declarations Acknowledgement The authors would like to thank all participants for contributing to this study. A special thank goes to Inge Stokholm, the secretary for the GP practice organization at SHS, for her indispensable assistance in the recruiting GP-participants, and to Caroline Margaret Moos for English proof reading and translation of participant citations. All data were processed in the online-based Research Electronic Data Capture system RedCap via OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark. Authors’ contributions: JHPR designed the semi-structured interview guide and conducted the focus-group interview together with LJK. JHPR and MS performed the coding of the results individually and any discrepancies was discussed. JHPR combined the codes into sub-themes and overall themes using the qualitative data analysis software Nvivo. NFR prepared figure 1-2. JHPR and NFR wrote the first draft of the manuscript and all authors contributed to the following manuscript development. All authors approved the final version. The corresponding author (NFR) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Competing interest No competing interests. Funding Funded by the University Hospital of Southern Denmark in Aabenraa. 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Mikkelsen TH, Søndergaard J, Kjaer NK, Nielsen JB, Ryg J, Kjeldsen LJ, et al. Handling polypharmacy –a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr. 2023;23(1):477. Spencer RA, Rodgers S, Salema N, Campbell SM, Avery AJ. Processing discharge summaries in general practice: a qualitative interview study with GPs and practice managers. BJGP Open. 2019;3(1):bjgpopen18X101625. Spencer RA, Spencer SEF, Rodgers S, Campbell SM, Avery AJ. Processing of discharge summaries in general practice: a retrospective record review. Br J Gen Pract. 2018;68(673):e576–85. Groene RO, Orrego C, Suñol R, Barach P, Groene O. It's like two worlds apart: an analysis of vulnerable patient handover practices at discharge from hospital. BMJ Qual Saf. 2012;21(Suppl 1Suppl1):i67–75. Lorenzati B, Quaranta C, Perotto M, Tartaglino B, Lauria G. Discharge communication is an important underestimated problem in emergency department. Intern Emerg Med. 2016;11(1):157–8. Newnham H, Barker A, Ritchie E, Hitchcock K, Gibbs H, Holton S. Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review. Int J Qual Health Care. 2017;29(6):752–68. Daliri S, Bekker CL, Buurman BM, Scholte op Reimer WJM, van den Bemt BJF. Karapinar – Çarkit F. Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients. BMC Health Serv Res. 2019;19(1):204. Kanaan AO, Donovan JL, Duchin NP, Field TS, Tjia J, Cutrona SL, et al. Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers Criteria Medications. J Am Geriatr Soc. 2013;61(11):1894–9. Cam H, Wennlöf B, Gillespie U, Franzon K, Nielsen EI, Ling M, et al. The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals' views. BMC Health Serv Res. 2023;23(1):1211. Styrelsen for Patientsikkerhed. Vejledning om epikriser [2024 12 – 08]. Available from: Available at: https://stps.dk/sundhedsfaglig/viola-viden-og-laering/risikoomraader/patientovergange/vejledning-omepikriser Styrelsen for Patientsikkerhed. Vejledning om epikriser VEJ nr 10036 af 30/11/2018 Copenhagen: Styrelsen for Patientsikkerhed. 2018. Retsinformation [2024 12 – 08]. Available from: https://www.retsinformation.dk/eli/retsinfo/2018/10036 Mikkelsen TH, Nielsen JB, Storsveen MM, Søndergaard J. Improving discharge summaries from hospital with a brief recommendation text box – results from a nationwide survey. BJGP Open. 2024:BJGPO.2024.0046. Elliott RA, Tan Y, Chan V, Richardson B, Tanner F, Dorevitch MI. Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability. Pharmacy. 2020;8(1):2. Ooi CE, Rofe O, Vienet M, Elliott RA. Improving communication of medication changes using a pharmacist-prepared discharge medication management summary. Int J Clin Pharm. 2017;39(2):394–402. Pevnick JM, Keller MS, Kennelty KA, Nuckols TK, Ko EM, Amer K, et al. The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization. Contemp Clin Trials. 2021;106:106419. Nguyen TA, Gilmartin-Thomas J, Tan ECK, Kalisch-Ellett L, Eshetie T, Gillam M, et al. The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review. J Alzheimers Dis. 2019;71(1):83–96. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older: A Randomized Controlled Trial. Arch Intern Med. 2009;169(9):894. Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004;2(4):257–64. Bergkvist A, Midlöv P, Höglund P, Larsson L, Bondesson A, Eriksson T. Improved quality in the hospital discharge summary reduces medication errors–LIMM: Landskrona Integrated Medicines Management. Eur J Clin Pharmacol. 2009;65(10):1037–46. deClifford J-M, Lam SS, Leung BK. Evaluation of a Pharmacist-Initiated E-Script Transcription Service for Discharged Patients. J Pharm Pract Res. 2009;39(1):39–42. Mogensen CB, Thisted AR, Olsen I. Medication problems are frequent and often serious in a Danish emergency department and may be discovered by clinical pharmacists. Dan Med J. 2012;59(11):A4532. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. Kitzinger J. Qualitative Research: Introducing focus groups. BMJ. 1995;311(7000):299–302. Bowling A. Research methods in health: investigating health and health services. Fourth edition. ed. Maidenhead, England: Open University Press; 2014 2014. Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, et al. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol. 2019;11(null):563–91. Ministry of Health. Healthcare in Denmark - an Overview. Version 1.2.ISBN: 978-87-7601-365-3. Copenhagen: Ministry of Health; 2017. Mikkelsen TH, Nielsen JB, Søndergaard J. Evaluering af den nye epikrisestandard og -vejledning. Evalueringsrapport. Syddansk Universitet: Forskningsenheden for Almen Praksis; 2021. 2021/11//. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. Håkansson Lindqvist M, Gustafsson M, Gallego G. Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study. Int J Clin Pharm. 2019;41(3):728–33. Sjölander M, Gustafsson M, Gallego G. Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden. Int J Clin Pharm. 2017;39(4):953–9. Scarfield P, Shepherd TD, Stapleton C, Starks A, Benn E, Khalid S, et al. Improving the quality and content of discharge summaries on acute medicine wards: a quality improvement project. BMJ Open Qual. 2022;11(2):e001780. McGrath SH, Snyder ME, Dueñas GG, Pringle JL, Smith RB, McGivney MS. Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis. J Am Pharmacists Association: JAPhA. 2010;50(1):67–71. Bryant L, Coster G, McCormick R. General practitioner perceptions of clinical medication reviews undertaken by community pharmacists. PubMed Commons J Prim Health Care. 2010;2(3):225–33. Chatterton B, Chen J, Schwarz EB, Karlin J. Primary Care Physicians' Perspectives on High-Quality Discharge Summaries. J Gen Intern Med. 2024;39(8):1438–43. Amin MEK, Nørgaard LS, Cavaco AM, Witry MJ, Hillman L, Cernasev A, et al. Establishing trustworthiness and authenticity in qualitative pharmacy research. Res Social Administrative Pharm. 2020;16(10):1472–82. Teherani A, Martimianakis T, Stenfors-Hayes T, Wadhwa A, Varpio L. Choosing a Qualitative Research Approach. J Grad Med Educ. 2015;7(4):669–70. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5758268","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399204315,"identity":"12dfd7e1-cb06-44e1-b574-dd661d1703fe","order_by":0,"name":"Joo Hanne Poulsen Revell","email":"","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Joo","middleName":"Hanne Poulsen","lastName":"Revell","suffix":""},{"id":399204316,"identity":"f8d2b8fc-a68e-43a2-ab33-964e362284ea","order_by":1,"name":"Nathalie Fogh Rasmussen","email":"data:image/png;base64,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","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":true,"prefix":"","firstName":"Nathalie","middleName":"Fogh","lastName":"Rasmussen","suffix":""},{"id":399204317,"identity":"7f2fe683-7131-49d5-96f0-774b8ab6a372","order_by":2,"name":"Maja Schlünsen","email":"","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Maja","middleName":"","lastName":"Schlünsen","suffix":""},{"id":399204318,"identity":"858121ba-b51a-48bd-94a3-f74726daf10d","order_by":3,"name":"Frans Brandt","email":"","orcid":"","institution":"University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Frans","middleName":"","lastName":"Brandt","suffix":""},{"id":399204319,"identity":"0de1cb35-18c0-4044-b1da-2aead1c86547","order_by":4,"name":"Morten Gammelgaard","email":"","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Morten","middleName":"","lastName":"Gammelgaard","suffix":""},{"id":399204320,"identity":"58340bee-d171-4041-9a31-df0b92cc57b8","order_by":5,"name":"Eva Holtved","email":"","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"","lastName":"Holtved","suffix":""},{"id":399204321,"identity":"aa9ed73b-330f-4365-8dfb-97770adb63d7","order_by":6,"name":"Jens Søndergaard","email":"","orcid":"","institution":"University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Jens","middleName":"","lastName":"Søndergaard","suffix":""},{"id":399204322,"identity":"f5c2b45d-cc77-4baa-aa69-81bed0ca4816","order_by":7,"name":"Donna Lykke Wolff","email":"","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Donna","middleName":"Lykke","lastName":"Wolff","suffix":""},{"id":399204323,"identity":"32269726-915d-4c65-82e9-e8b01d0c1080","order_by":8,"name":"Lene Juel Kjeldsen","email":"","orcid":"","institution":"University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Lene","middleName":"Juel","lastName":"Kjeldsen","suffix":""}],"badges":[],"createdAt":"2025-01-03 12:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5758268/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5758268/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73518086,"identity":"b4152bd6-3417-438f-8001-7852b4874aac","added_by":"auto","created_at":"2025-01-10 17:59:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22060,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInformation standards and color codings in the Danish discharge summaries\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: Translated and adapted from “Den nye epikrisestandard – pixie til praksis om den styrkede opfølgningsindsats i almen praksis” [The new discharge summary standard – a practical guide to the strengthened follow-up effort in general practice], available at: https://www.sundhed.dk/sundhedsfaglig/information-til-praksis/midtjylland/almen-praksis/patientbehandling/patientforloeb/henvisning-visitation/vejledninger-retningslinjer/ny-epikrisestandard/ and ”Retsinformtion. VEJ nr 10036 af 30/11/2018. Vejledning om Epikriser” [Legal information no 10036 or 30/11/2018 Guide on Discharge Summaries], available at: https://www.retsinformation.dk/eli/retsinfo/2018/10036\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5758268/v1/f7fe8a072bfdf293a5e37718.png"},{"id":73518091,"identity":"9360fb75-a991-4d33-8dfc-172bb6ba83ae","added_by":"auto","created_at":"2025-01-10 17:59:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33295,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of the three main themes along with their sub-themes that summarize healthcare professionals’ perceptions of and challenges in the current exchange of medication information in discharge summaries between an emergency hospital department and general practice and their views on relevant medication-related content from a pharmacist-led medication review.\u003c/p\u003e","description":"","filename":"Onlinedrawingimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5758268/v1/095f85bdd8075a86c5bbf1dd.png"},{"id":76619517,"identity":"23a1d260-2a53-4a66-a915-2a636770546e","added_by":"auto","created_at":"2025-02-19 04:16:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1265880,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5758268/v1/cacb7546-01e8-4095-bda3-d1d7bfcbc18b.pdf"},{"id":73518089,"identity":"f1297a17-a55f-44a7-af77-8590845bac56","added_by":"auto","created_at":"2025-01-10 17:59:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":206756,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.COREQguidelines.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5758268/v1/d26d59870c80874f8e131e6c.pdf"},{"id":73518087,"identity":"588d188a-1bd2-4b03-a6e1-1b545100af8e","added_by":"auto","created_at":"2025-01-10 17:59:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19525,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile2.Semistructuredinterviewguideforfocusgroupinterview.docx","url":"https://assets-eu.researchsquare.com/files/rs-5758268/v1/1c5d003a4e46767c047f2ec7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sharing of relevant medication information through discharge summaries in an acute setting – perspectives from hospital-based physicians, general practitioners and clinical pharmacists","fulltext":[{"header":"Background","content":"\u003cp\u003ePoor-quality discharge summaries, especially when it comes to medication information, can lead to adverse outcomes, such as adverse drug events, readmissions to hospital, or even death, due to e.g. medication errors or lack of medication information (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Therefore, effective discharge communication and coordination between healthcare professionals across sectors in relation to patients\u0026rsquo; medication become important for the prevention of adverse outcomes in the transition of patients (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, discharge communication becomes especially challenging in the care of multimorbid elderly patients as they often have complex needs, use multiple medications, and are at high risk of experiencing adverse drug events and interactions (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Thus, the quality of the medication information provided in discharge summaries play a significant role in patient transition across healthcare sectors.\u003c/p\u003e \u003cp\u003eIt is common practice across countries to include recommendations to the general practitioner (GP) in the discharge summaries when patients are discharged from hospital. During follow-up by the patient\u0026rsquo;s GP, information flow is crucial, but challenging due to the massive amount of data registered for each patient at the hospital combined with a GP\u0026rsquo;s lack of time to review the hospital discharge summaries. Since 2019, Danish hospital-based physicians have been obliged to highlight within the discharge summary whether there is a recommendation for GP follow up that consists of a brief and precise statement of the suggested action in a recommendation text box (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The purpose of the highlight is to ensure that only necessary information is included to generate a more focused discharge summary (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to a more focused information flow, reduction of medication discrepancies, adverse drug events and general patient outcomes has been associated with including clinical pharmacists\u0026rsquo; recommendations in the discharge process (\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). One Danish study described that 25% of all emergency department patients were identified by clinical pharmacists to have medication issues, of which 47% were considered to be serious (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Introducing clinical pharmacist recommendations to a discharge summary could simply contribute additional information to an already overloaded information flow across healthcare sectors. However, recommendations about medication issues are vital to ensure GPs can take the appropriate action. Therefore, the aim of this study was to explore healthcare professionals\u0026rsquo; perceptions of the exchange of medication information in discharge summaries between an emergency hospital department and general practice to tailor the communication of recommendations from a clinical pharmacist after a medication review ensuring a safer transition between healthcare sectors for the patient in a Danish setting.\u003c/p\u003e \u003cp\u003eMethod\u003c/p\u003e"},{"header":"Study design","content":"\u003cp\u003eThis qualitative focus group interview (FGI) study was conducted in April 2024 and adheres to the Consolidated Criteria for Reporting Qualitative Research recommendations (COREQ, supplementary file 1) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). FGI was chosen as a method to obtain in-depth knowledge about the perspectives on the exchange of medication information in discharge summaries. FGIs are facilitated group discussions, where open-ended questions are asked in interactive group settings, where participants can interact with other group members (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). An experienced facilitator led the FGI, and one junior researcher was present as an observer. The interview took place in a meeting room at the University Hospital of Southern Denmark in Aabenraa (SHS).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThe Danish health care system is currently organized into three administrative levels: the national level (State), the regional level (5 Regions), and the local level (98 Municipalities). The state holds the overall regulatory and supervisory functions in health and elderly care. The five regions are primarily responsible for the hospitals, the general practitioners (GPs) and for psychiatric care. The 98 municipalities are responsible for a number of primary healthcare services as well as for elderly care. GPs practice privately and work according to a collective agreement, subject to periodic renegotiations between the government and the physicians\u0026rsquo; union. Remuneration is based on a combination of capitation (based on patient lists) and fee-for-service (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe emergency department (FAM) at SHS comprises 42 patient beds and an average patient flow of 120 patients per day from a catchment area of approximately 225,000 inhabitants. During the day, there are regular rounds by the hospital-based physician in charge of each patient's care, where a diagnosis is given and treatment planned. Short-stay patients will be discharged to home and eventually followed up by a GP in one of the 80 general practice clinics in the catchment area of SHS. Currently, a pharmacy technician (pharmaconomist) is present eight hours a day at FAM and conducts medication history and reconciles patients\u0026rsquo; medication. In a potentially new service consisting of pharmacist-led medication reviews for elderly polypharmacy patients at FAM, the pharmacists would reconsile and review the patients\u0026rsquo; medication and preferably validate it with a patient interview. The pharmacist\u0026rsquo;s medical recommendations would be included in the written discharge summary. The discussion in the FGI was based on this premise.\u003c/p\u003e \u003cp\u003eIn Denmark, all discharge summaries, where follow-up is deemed necessary, are color-coded by the hospital-based physician according to urgency. The color code is displayed at the top of the summary if follow-up by the GP is needed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecruitment of participants\u003c/h3\u003e\n\u003cp\u003ePurposive sampling was used to assemble focus group participants from hospitals and general practice. The purposive sampling allowed the researchers to select individuals, who represented the demographics of healthcare professionals within the catchment area of SHS in terms of practice area, age, gender, and years of practice experience (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The hospital management at FAM and at the hospital pharmacy assisted in the recruitment of hospital-based physicians and pharmacists, respectively. The GP participants were identified through the GP coordinators\u0026rsquo; network, which represent all GP practices in the local area. Letters of invitation to participate in the focus group were sent via e-mail and those interested contacted the researcher or the GP coordinator. GPs of all grades were eligible to take part in the focus group.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview guide (supplementary file 2) was developed based on previous experience with pharmacist-led recommendations conveyed through discharge summaries and the literature (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eA reflexive thematic analysis was used to identify key themes (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The coding and the development of themes include familiarization with the data by reading the transcripts multiple times, generating initial codes, searching for themes, reviewing themes, and defining and naming themes (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Two authors (JHPR and MS) performed the coding individually and any discrepancies was discussed. The first author (JHPR) combined the codes into sub-themes and overall themes using the qualitative data analysis software Nvivo.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e This study is part of a RCT where approval is granted from clinicaltrails.gov (Clinical Trial Number: NCT06451692 \u0026ndash; Date: 11-06-2024), together with the approval to store data in accordance to regional policy (24/12239). As data will not contain identification of participants, and the study is not a biomedical study, approval from the National Ethic Committee was not required.\u003c/p\u003e \u003cp\u003eWritten information was provided to group participants about the purpose of the focus group and their involvement. Informed consent was obtained from each member, before conducting the FGI indicating willingness to participate, agreement for the FGI to be audio and video recorded, and potential publication of study results in an anonymized form. The FGI was audio recorded and transcribed verbatim.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOne FGI was held with nine participants and went for approximately 150 minutes. The focus group consisted of four hospital-based physicians (including a clinical pharmacologist), three general practitioners, and two clinical pharmacists. The hospital-based physicians were specialized in acute medicine and pharmacology, the clinical pharmacists provided clinical ward-based pharmacy services to SHS, and the GPs each represented different sizes of practice partnerships. The participants\u0026rsquo; experience levels varied from early career to experienced physicians, pharmacists and GPs and some participants in the FGI were known to each other. In the following analysis and discussion, the participants are numbered according to their focus group representations (Hospital-based physician 1\u0026ndash;4, GP 1\u0026ndash;3, and Pharmacist 1\u0026ndash;2).\u003c/p\u003e \u003cp\u003eThe thematic analysis revealed three main themes: 1) Challenges with the usability and implementability of medication content in discharge summaries, 2) Different healthcare practices affect the management of medication information from discharge summaries, and 3) How to tailor pharmacist-led recommendations from medication reviews. These main themes each hold three sub-themes. In the following, the themes are represented by selected quotes from participants, independent of the number of participants mentioning them. An overview of the main themes and sub-themes is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 1: Challenges with the usability and implementability of medication content in discharge summaries\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 1.1: Discharge summaries should include key information and straight-to-the-point information\u003c/h2\u003e \u003cp\u003e All participants found the exchange of medication information through discharge summaries between hospital and general practice essential. However, the GPs stated the importance of receiving overall information about potential medication changes and the course of action during admission, together with a follow-up plan after discharge.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For me, in practice, it\u0026rsquo;s important to know why the person has come in, what has been done \u0026ndash; not in any detail... and most importantly, what the plan is. Should there be follow-up, or shouldn\u0026rsquo;t there be follow-up [in general practice]\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, I think it\u0026rsquo;s helpful, at least, if medication changes have been made, that it\u0026rsquo;s clear what the reasons are \u0026ndash; that its written why a change has been made\u0026rdquo; [Hospital-based physician 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBased on previous experience of very long discharge summaries, the GPs prefer the information to be short and to the point to ensure user-friendliness is increased in general practice.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think the \u0026lsquo;best\u0026rsquo; example is like a six or seven-page report to do with shortness of breath \u0026ndash; you lose track of the information, and the patient arrives and still has shortness of breath, and you\u0026rsquo;re still not quite sure what\u0026rsquo;s actually happened and what the plan really is. No one has an overview. So, the best thing would be three lines about \u0026lsquo;this happened, so the plan is that, and maybe to clearly mark it red, yellow, or green. Then I\u0026rsquo;d be satisfied\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 1.2: Hospital-based physicians lack information about the rationale with specific medication treatments\u003c/h2\u003e \u003cp\u003eIn addition, the hospital-based physicians agreed that they lacked information about the rationale behind the prescribed medications from the GPs perspective. However, a high patient flow and unfamiliarity with the rationale behind specific medication treatments may explain why hospital physicians are not always able to provide detailed medication information needed by GPs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;And we [hospital doctors] often discuss this \u0026ndash; we wonder, why a patient is on prednisolone, or why they are on two antidepressants, and now they\u0026rsquo;ve been admitted with a little hyponatraemia, and that\u0026rsquo;s just wrong\u0026ndash; Write it down! I mean, give it back to you [GPs], because there might be reasons we can\u0026rsquo;t figure out, so if it\u0026rsquo;s not critical where we need to pause or discontinue it [medication], then write it to you... But we don\u0026rsquo;t do that very often because things move very quickly\u0026rdquo; [Hospital-based physician 2]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Everyone thinks patients take too much medication... But we just don\u0026rsquo;t have the time to look closely into it\u0026rdquo; [Hospital-based physician 3]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 1.3: Challenges with the usability of the updated medication list in practice\u003c/h2\u003e \u003cp\u003eAlthough, an updated medication list is a standard part of the discharge summary, the medication information is not always approved and available to the hospital-based medical secretary. Thus, an up-to-date medication list does not appear in the discharge summary, preventing discharge summaries reaching an expected standard.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;the medication list wasn\u0026rsquo;t always available, even though she [hospital-based medical secretary] wrote the discharge summary\u0026hellip; and then they discharge them [the patients] without it, so therefore you sometimes receive them [discharge summaries] without the medication list\u0026rdquo; [Pharmacist 2]\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn addition, the usefulness of receiving the updated medication list after discharge varied between GPs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think it\u0026rsquo;s actually helpful when a discharge summary includes information about the medication they\u0026rsquo;re prescribed\u0026rdquo; [GP 3]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I almost exclusively use the Shared Medication Card\u0026rdquo; [GP 2]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, the full list, I don\u0026rsquo;t really\u0026hellip; I don\u0026rsquo;t think I\u0026rsquo;ve actually used it, to be honest, the one that\u0026rsquo;s in the discharge summary\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Different healthcare practices affect the management of medication information from discharge summaries\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme 2.1: The discharge summaries are not always read by the GPs\u003c/h2\u003e \u003cp\u003eThe practical management of incoming discharge summaries and the time frame for reading and acting on them, vary among GPs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some GP practices have simply decided not to read the discharge summaries. (\u0026hellip;) because we just don\u0026rsquo;t have the resources to wade through everything. (\u0026hellip;) discharge summaries can sit there and only get read after a week or so\u0026rdquo; [GP 3]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In regards to trying to read discharge summaries, we have a person to manage the post and distribute them to the specific GP who knows the patient, and then it\u0026rsquo;s the GP\u0026rsquo;s responsibility to follow it up\u0026rdquo; [GP 2]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 2.2: The color coding is interpreted differently among healthcare professionals\u003c/h2\u003e \u003cp\u003e Further, the participants discussed the color-coding of the discharge summaries in terms of the urgency for GPs to act and the interpretation and understanding varied among participants.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think we\u0026rsquo;ve come much closer to something that works well, like \u0026lsquo;red-yellow-green\u0026rsquo; \u0026hellip; I also think many people now have an understanding of what it actually means for the recipient. I mean, what it means when a red, yellow, or green discharge summary is issued. I still think there are many who maybe struggle to understand the purpose of the system, and that\u0026rsquo;s why sometimes it still goes wrong\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We [pharmacists] have figured out how to use them now, so we often issue yellow marking[in the discharge summary] because we think it\u0026rsquo;s something the doctors should respond to\u0026rdquo; [Pharmacist 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;it [yellow discharge summary] also implies that the patients don\u0026rsquo;t have a relative who can make contact for them, or a career, or something like that\u0026hellip; So actually, very few people need a yellow discharge summary. There\u0026rsquo;s also an element of personal responsibility in it. I mean, it\u0026rsquo;s not like\u0026hellip; in that sense, the doctor isn\u0026rsquo;t a support worker\u0026rdquo; [Hospital-based physician 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSub-theme 2.3: Hospital-based physicians are not always aware of the information load in a general practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFurther, GPs receive an extensive number of discharge summaries daily, which was a new revelation to the hospital-based physicians, who acknowledged the importance of sharing this information with other hospital-based physicians.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We have the equivalent of around 5,000 patients, and we probably receive\u0026hellip; well, just under 100 discharge summaries every day. So, if we\u0026rsquo;re supposed to read through them and grasp the meaningful parts\u0026hellip; we can\u0026rsquo;t sit there and act on it all. Discharge summaries are information for us. If there\u0026rsquo;s something we need to do, it\u0026rsquo;s really hard to grasp it in the endless stream of incoming things\u0026rdquo; [GP 3]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think the point about receiving 100 discharge summaries a day was really helpful information for me, and it\u0026rsquo;s the sort of thing we can communicate to our junior doctors, so they\u0026rsquo;re aware of it\u0026rdquo; [Hospital-based physician 3]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: How to tailor pharmacist-led recommendations from medication reviews\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSub-theme 3.1: Information on medication compliance and polypharmacy should be included and be kept short, simple and summative and placed at the top of the discharge summary\u003c/b\u003e \u003c/p\u003e \u003cp\u003eVarious views on relevant medication-related content from a pharmacist-led medication review, such as compliance issues, patient attitudes towards medicine, and polypharmacy were discussed among participants.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I do think it\u0026rsquo;s good to know if I\u0026rsquo;ve started something, and the patient hasn\u0026rsquo;t picked up the medication or hasn\u0026rsquo;t started taking it\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;we\u0026rsquo;ve done quite a bit of detective work, talking to the patient and looking at what preceded this [medication before admission]... Also talking to the patients about what they want\u0026hellip; what medications they like taking, what they don\u0026rsquo;t like, what they prefer, and what their motivation is for taking medicine, and how their compliance is.\u0026rdquo; [Pharmacist 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think it\u0026rsquo;s the polypharmacy... I mean, getting it sorted out, because it\u0026rsquo;s a really big burden for patients to have to take all that [many medications], even though it probably doesn\u0026rsquo;t make any difference. It\u0026rsquo;s a big burden for them... And yes, the anticholinergic burden is also something we probably overlook quite a lot in the hospital\u0026rdquo; [Hospital-based physician 2]\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConcerning the sharing of the pharmacists recommendations regarding medicine in the discharge summaries, all participants agreed that the format should be kept short, simple, and summative.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In reality, the discharge summary should be concise enough to serve as a conclusion to everything else\u0026hellip; That means a red, yellow, green summary of maximum of three, four, maybe five lines, briefly stating what medication changes have been made and the reasons for them, along with the pharmacist\u0026rsquo;s recommendations, if there\u0026rsquo;s been one involved with \u0026lsquo;be aware of this and that\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It should just be the pharmacist\u0026rsquo;s suggestions: 1, 2, 3, in order of priority\u0026hellip; then you [the responsible physician] can consider whether or not you agree\u0026rdquo; [Hospital-based physician 3]\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn response to the question of where they would prefer the pharmacist\u0026rsquo;s recommendations to be placed in the discharge summary, there was agreement among all participants that it should be included under the conclusion at the top:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It just needs to be included under the conclusion, because that's what we read\u0026rdquo; [GP 2]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, exactly. That\u0026rsquo;s what will appear at the top\u0026mdash;in some systems, at least\u0026rdquo; [Hospital-based physician 1]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 3.2: Pharmacists\u0026rsquo; recommendations should be kept evidence-based\u003c/h2\u003e \u003cp\u003eSome hospital-based physicians and GPs had previously collaborated with clinical pharmacists, describing the pharmacist-led medication reviews as highly educational.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip; there\u0026rsquo;s also a lot of learning from these medication reviews. I remember from geriatrics\u0026hellip; \u0026lsquo;Pantoprazole, ulcer for four weeks, now they\u0026rsquo;ve been on it for three years \u0026ndash; is it really indicated, question mark\u0026rsquo;\u0026hellip; So, there\u0026rsquo;s really valuable learning for us [doctors], and you get really good at reviewing things like pantoprazole and aspirin, and all those medications that should be stopped or reassessed at some point\u0026rdquo; [Hospital-based physician 2]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I know that at one point it was pharmacists who did these pharmacy rounds and made recommendations like \u0026lsquo;be aware of this\u0026rsquo;, \u0026lsquo;maybe you should consider changing this\u0026rsquo;. These are the kinds of things I\u0026rsquo;d actually like to see, especially if someone\u0026rsquo;s been hospitalised for a long time and there may have been five recommendations from a pharmacist that haven\u0026rsquo;t been implemented for some reason. And really, it\u0026rsquo;s probably something that should be part of our domain, not so much the hospital\u0026rsquo;s, because we have the long-term relationship with the patient. It would be interesting to get that included in the discharge summary \u0026ndash; the pharmacist\u0026rsquo;s recommendations\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn addition, all participants agreed that pharmacists should contribute with their professional knowledge about medicine, and potential pharmacist-led recommendations should be kept evidence-based.\u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;As I remember your medication reviews, they were very objective and evidence-based\u0026hellip; Dual antiplatelet therapy, 12 months after PCI, and now it\u0026rsquo;s been 3 years. So, it\u0026rsquo;s up to the doctor to decide\u0026hellip; But you kept it completely objective, and it was evidence-based\u0026hellip; And that\u0026rsquo;s always evolving, the guidelines, and you\u0026rsquo;re astute about that\u0026rdquo; [Hospital-based physician 2]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It can be a bit difficult to be aware of certain things [medical issues]\u0026hellip; if the doctor doesn\u0026rsquo;t know what to be aware of. This is where your professionalism as pharmacists really comes in. Because it\u0026rsquo;s about the combination and the whole person\u0026hellip; The primary focus is on the medications, so it\u0026rsquo;s important to contribute your expertise\u0026rdquo; [Hospital-based physician 4]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You\u0026rsquo;re allowed to be a bit tough on some of the recommendations. For instance, alendronate prescribed for 15 years \u0026ndash; cancel it\u0026rdquo; [GP 1]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 3.3: Recommendations related to outpatients\u0026rsquo; medication should be directed to the outpatient clinics\u003c/h2\u003e \u003cp\u003eThe GPs found it challenging to maintain an overview of a patient\u0026rsquo;s medication when they were followed at outpatient clinic(s). Thus, potential pharmacist-led medical recommendations should be directed to the outpatient clinics instead of the GP.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Those [patients] we have for ourselves [in general practice] are much easier because we have a full overview, but the issue is being aware if they attend different outpatient clinics, then there is some medication they\u0026rsquo;re receiving there \u0026ndash; we\u0026rsquo;re not really involved in that. And it also means that if you [the pharmacist]come with some recommendations, you need to keep in mind that if it\u0026rsquo;s that medication, then it\u0026rsquo;s actually that outpatient clinic you should be talking to, not the GP\u0026hellip; Ideally, we [GPs] shouldn\u0026rsquo;t interfere with what they\u0026rsquo;re doing in the outpatient clinic\u0026hellip; I think it\u0026rsquo;s a huge problem\u0026rdquo; [GP 3]\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip; it would be good if your correspondence [pharmacist recommendations] were sent to the outpatient clinic. For example: We\u0026rsquo;ve done a medication review, we think this is a little odd and therefore suggest X,. I also think some of the medications prescribed from some outpatient clinics as ridiculous, and of course, it\u0026rsquo;s not the GP who has the authority\u0026rdquo; [Hospital-based physician 3]\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we found that concise and precise information is paramount for the GPs who receive and act on the provided information in discharge summaries. We identified three main themes from the thematic analysis of the focus group interview: Theme 1) \u003cem\u003eChallenges with the usability and implementability of medication content in discharge summaries\u003c/em\u003e described the three sub-themes indicating that discharge summaries should include key information and to-the-point information, hospital-based physicians lack information about the rationale with specific medication treatments, and that there are different views on the usability of the updated medication list in practice. Theme 2) \u003cem\u003eDifferent healthcare practices affect the management of medication information from discharge summaries\u003c/em\u003e depicted three major challenges as described in the sub-themes including that the discharge summaries are not always read by the GPs, the color coding are interpreted differently among healthcare professionals, and the hospital-based physicians are not always aware of the information load in general practice. Theme 3) \u003cem\u003eHow to tailor pharmacist-led recommendations from medication reviews\u003c/em\u003e identified characteristics of relevant medication-related content from a pharmacist-led recommendation review to include in the discharge summaries, i.e. information on medication compliance and polypharmacy, and pharmacists\u0026rsquo; recommendations should be placed at the top of the discharge summary, be evidence-based and if the recommendations are related to outpatients\u0026rsquo; medication they should be directed to the outpatient clinics. Overall, the focus group participants agreed that including pharmacists\u0026rsquo; recommendations in discharge summaries would increase the professional standard of discharge summaries. Thus, the results of this study contribute to understanding healthcare professionals\u0026rsquo; perceived challenges and perspectives on the relevance of specific information in the exchange of medication information in discharge summaries between an emergency hospital department and general practice in a Danish setting.\u003c/p\u003e \u003cp\u003eOur findings support previous research in other countries demonstrating a positive attitude towards pharmacist-led recommendations in discharge summaries as a resource in the care transition between secondary and primary healthcare (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). However, the FGI identified some challenges similar to other findings reported in the literature. For example, technical limitations result in non-updated or inaccessible medications lists (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), the high patient flow means that hospital-based physicians cannot always provide optimal medication information and GPs cannot prioritize sufficient time to review discharge summaries for all patients (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The participants\u0026rsquo; solutions were similar to those proposed in previous studies, i.e. auto-generation of medication changes and streamlining of patient color coding practice among the healthcare staff (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In this study, the participants also referred to the conclusion placed at the top of the discharge summary, i.e. the obligatory recommendation text box (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), as the most important part of the summary. This indicates the need for very concise information as this part is often the only one the GPs read. The experience by GPs with the recommendation text box has also been described in a Danish nationwide survey study showing that the box is easy to find and provides brief and precise information about recommended follow-up (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Working with a standard operating procedure has been described in a previous quality improvement project on acute medicine wards, where the implementation of a template for discharge summary completion significantly improved the content and quality of discharge summaries on the acute medical wards (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNone of the participants expressed concerns about the clinical pharmacists\u0026rsquo; expertise or role. On the contrary, they characterized their expertise as being very \u0026lsquo;evidence-based\u0026rsquo; and emphasized the importance of ensuring that pharmacists\u0026rsquo; recommendations in discharge summaries are kept evidence-based. Mutual respect among the participants was observed in the discussion of views on relevant medication-related content from a pharmacist-led medication review. The GPs and hospital-based physicians were aware that the responsibility for follow-up was placed with the GPs and that the pharmacist's notes were meant as recommendations, not orders. Thus, they all agreed that the pharmacist\u0026rsquo;s recommendations should be written precisely and prioritized with no need for \u0026lsquo;empty words\u0026rsquo; and polite phrases. These perceptions may be unique for the participants in this specific focus group or for the communication culture in the Danish healthcare system. However, other studies also reported similar positive views towards clinical pharmacists (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) although there were some exceptions (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The complexities of discharge summaries for patients receiving outpatient care were also discussed. The GPs suggested the information that required outpatient follow-up should be directly handed over from the inpatient hospital department to the outpatient hospital clinic, and thus, the follow-up actions on outpatient care matters should not go through the GP. Contrary to this, the GPs in a US interview study of primary care physicians\u0026rsquo; perspectives on high‑quality discharge summaries, suggested a specific section in the discharge summary to highlight and group follow-up items needed immediately after discharge, i.e. outpatient referrals which need to be placed by the primary care physician (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Outpatient care in the US healthcare system is not directly comparable to outpatient care in a Danish setting, However, outpatient care in the US is often placed at independent outpatient clinics outside the jurisdiction of hospitals, whereas in Denmark, the outpatient clinics are part of the hospital.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA major strength of using a qualitative method to study healthcare professionals\u0026rsquo; perceptions of the current exchange of medication information in discharge summaries is the in-depth real-world information about participants\u0026rsquo; perceptions and what has been experienced by each participant (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Moreover, it strengthened the study that all participants answered relevantly and participated in the dialogue with the interviewer and the other informants, maintaining mutual respect for the various professions represented. However, bias may occur if the participants affect each other in a way that they do not speak their minds. In this study, the participation of GPs, hospital-based physicians, and clinical pharmacists together may have caused the participants to moderate their opinions to avoid offending one another. To overcome this bias, the interviewers offered opportunities to explore different opinions and experiences by asking open-ended questions and additional clarifying questions. Furthermore, the credibility of the study was strengthened for several reasons: 1) the research team consisted of members with diverse backgrounds in both research experience and academic fields, specifically within social pharmacy and clinical pharmacy and 2) two researchers carried out the process of meaning condensation independently and subsequently discussed potential discrepancies before the final themes were determined (investigator triangulation).\u003c/p\u003e \u003cp\u003eA limitation of the study was the completion of only one focus group interview, thus, there was a risk of not achieving data saturation. However, we used an exploratory research design and did not expect data saturation (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Moreover, a group size of nine participants allowed the inclusion of two or more representatives from each profession, but the study may have been strengthened further if younger, less experienced physicians had been represented as they may have contributed with alternative views. Lastly, this study included only healthcare professionals in the proximity of SHS in Aabenraa only, limiting the generalizability to other general practices and hospitals nationally and internationally.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eImplications for future practice and research\u003c/h2\u003e \u003cp\u003eDuring the interviews, the different professions gained valuable insights into each other's processes, highlighting areas for potential improvement. Thus, providing opportunities for communication and collaboration between GPs, hospital physicians and clinical pharmacists could further improve the healthcare professionals\u0026rsquo; understanding of the rationale with specific medication treatments and thus improve discharge summaries\u0026rsquo; content. More specifically, the results of this study indicated that information on medication should be summative and placed at the top of the discharge summary and focused on medication changes, reasons for these changes, polypharmacy, compliance and pharmacists\u0026rsquo; recommendations on medications requiring GP review. In addition, to improve discharge summaries a unified understanding of the yellow color code is needed, as interpretations vary among GPs, hospital physicians, and pharmacists. Innovative solutions such as auto-generation of medication changes and technical improvements to prevent non-updated or inaccessible medications lists are also encouraged.\u003c/p\u003e \u003cp\u003eGPs may perceive pharmacists' recommendations as adding to their workload, with a high patient flow and time constraints being a significant challenge (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) highlighted by the participating GPs in this study. Organizational factors in general practice might limit the capacity to allocate more time for these tasks. Further work is needed to balance the information provided whilst not contributing to information overload.\u003c/p\u003e \u003cp\u003eFuture research could explore whether GPs act on pharmacists' recommendations and their impact on patient outcomes, which would help validate the quality of these recommendations. Additionally, since many elderly patients with multiple chronic conditions receive care in various outpatient clinics, future intervention studies should test the effect of pharmacist recommendations in discharge summaries in supporting a safe transition for outpatients between primary and secondary care, ensuring critical information is preserved.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis FGI study enhances our understanding of which medication-related information in discharge summaries is most important for GPs. The study found that medication-related information in discharge summaries must be concise and to the point, and that pharmacist\u0026rsquo;s recommendations in discharge summaries are valued by GPs and hospital physicians. Most importantly for future practice, the study results revealed that to further improve discharge summaries, it is essential to establish standardized routines and a shared understanding of the elements in the existing format, and eventually, innovative technological solutions ensuring that the receiver of the information is able to easily find, understand, and act upon the information. Moreover, exchange of medication information for outpatients needs to be evaluated further.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all participants for contributing to this study. A special thank goes to Inge Stokholm, the secretary for the GP practice organization at SHS, for her indispensable assistance in the recruiting GP-participants, and to Caroline Margaret Moos for English proof reading and translation of participant citations. All data were processed in the online-based Research Electronic Data Capture system RedCap via OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions: \u003c/h2\u003e\n\u003cp\u003eJHPR designed the semi-structured interview guide and conducted the focus-group interview together with LJK.\u0026nbsp;JHPR and MS performed the coding of the results individually and any discrepancies was discussed. JHPR combined the codes into sub-themes and overall themes using the qualitative data analysis software Nvivo. NFR prepared figure 1-2. JHPR and NFR wrote the first draft of the manuscript and all authors contributed to the following manuscript development. All authors approved the final version. The corresponding author (NFR) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.\u003c/p\u003e\n\u003ch2\u003eCompeting interest\u003c/h2\u003e\n\u003cp\u003eNo competing interests.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eFunded by the University Hospital of Southern Denmark in Aabenraa.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u0026apos;\u003c/h2\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is not publicly available due to the need for confidentiality, but is available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWimsett J, Harper A, Jones P. Review article: Components of a good quality discharge summary: a systematic review. 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BMC Health Serv Res. 2023;23(1):1211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStyrelsen for Patientsikkerhed. Vejledning om epikriser [2024 12\u0026thinsp;\u0026ndash;\u0026thinsp;08]. Available from: Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://stps.dk/sundhedsfaglig/viola-viden-og-laering/risikoomraader/patientovergange/vejledning-omepikriser\u003c/span\u003e\u003cspan address=\"https://stps.dk/sundhedsfaglig/viola-viden-og-laering/risikoomraader/patientovergange/vejledning-omepikriser\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStyrelsen for Patientsikkerhed. Vejledning om epikriser VEJ nr 10036 af 30/11/2018 Copenhagen: Styrelsen for Patientsikkerhed. 2018. Retsinformation [2024 12\u0026thinsp;\u0026ndash;\u0026thinsp;08]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.retsinformation.dk/eli/retsinfo/2018/10036\u003c/span\u003e\u003cspan address=\"https://www.retsinformation.dk/eli/retsinfo/2018/10036\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMikkelsen TH, Nielsen JB, Storsveen MM, S\u0026oslash;ndergaard J. Improving discharge summaries from hospital with a brief recommendation text box \u0026ndash; results from a nationwide survey. BJGP Open. 2024:BJGPO.2024.0046.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElliott RA, Tan Y, Chan V, Richardson B, Tanner F, Dorevitch MI. Pharmacist\u0026ndash;Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability. Pharmacy. 2020;8(1):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOoi CE, Rofe O, Vienet M, Elliott RA. Improving communication of medication changes using a pharmacist-prepared discharge medication management summary. Int J Clin Pharm. 2017;39(2):394\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePevnick JM, Keller MS, Kennelty KA, Nuckols TK, Ko EM, Amer K, et al. The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization. Contemp Clin Trials. 2021;106:106419.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen TA, Gilmartin-Thomas J, Tan ECK, Kalisch-Ellett L, Eshetie T, Gillam M, et al. The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review. 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Int J Qual Health Care. 2007;19(6):349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitzinger J. Qualitative Research: Introducing focus groups. BMJ. 1995;311(7000):299\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowling A. Research methods in health: investigating health and health services. Fourth edition. ed. Maidenhead, England: Open University Press; 2014 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt M, Schmidt SAJ, Adelborg K, Sundb\u0026oslash;ll J, Laugesen K, Ehrenstein V, et al. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol. 2019;11(null):563\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health. Healthcare in Denmark - an Overview. Version 1.2.ISBN: 978-87-7601-365-3. Copenhagen: Ministry of Health; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMikkelsen TH, Nielsen JB, S\u0026oslash;ndergaard J. Evaluering af den nye epikrisestandard og -vejledning. Evalueringsrapport. Syddansk Universitet: Forskningsenheden for Almen Praksis; 2021. 2021/11//.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026aring;kansson Lindqvist M, Gustafsson M, Gallego G. Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study. Int J Clin Pharm. 2019;41(3):728\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026ouml;lander M, Gustafsson M, Gallego G. Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden. Int J Clin Pharm. 2017;39(4):953\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScarfield P, Shepherd TD, Stapleton C, Starks A, Benn E, Khalid S, et al. Improving the quality and content of discharge summaries on acute medicine wards: a quality improvement project. BMJ Open Qual. 2022;11(2):e001780.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGrath SH, Snyder ME, Due\u0026ntilde;as GG, Pringle JL, Smith RB, McGivney MS. Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis. J Am Pharmacists Association: JAPhA. 2010;50(1):67\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBryant L, Coster G, McCormick R. General practitioner perceptions of clinical medication reviews undertaken by community pharmacists. PubMed Commons J Prim Health Care. 2010;2(3):225\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChatterton B, Chen J, Schwarz EB, Karlin J. Primary Care Physicians' Perspectives on High-Quality Discharge Summaries. J Gen Intern Med. 2024;39(8):1438\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmin MEK, N\u0026oslash;rgaard LS, Cavaco AM, Witry MJ, Hillman L, Cernasev A, et al. Establishing trustworthiness and authenticity in qualitative pharmacy research. Res Social Administrative Pharm. 2020;16(10):1472\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeherani A, Martimianakis T, Stenfors-Hayes T, Wadhwa A, Varpio L. Choosing a Qualitative Research Approach. J Grad Med Educ. 2015;7(4):669\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5758268/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5758268/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePoor-quality discharge summaries, particularly regarding medication information, can lead to adverse drug events, readmissions or even to death. Therefore, effective medication communication across sectors is crucial, especially for multimorbid elderly patients, who are at high risk due to polypharmacy and complex needs. While pharmacists\u0026rsquo; recommendations improve discharge quality, they also add to the information flow. This focus group interview study aims to explore healthcare professionals\u0026rsquo; perceptions of the current exchange of medication information in discharge summaries between an emergency hospital department and general practice to tailor the communication of recommendations from a clinical pharmacist after a medication review ensuring a safer transition between healthcare sectors for patients in Denmark.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA semi-structured focus group interview was conducted with nine healthcare professionals from primary and secondary healthcare sector. Data were synthesized independently by two researchers using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total, the focus group interview included nine participants (four hospital-based physicians (including a clinical pharmacologist), three general practitioners (GPs), and two clinical pharmacists). We identified three themes each including three sub-themes from the thematic analysis: Theme 1) \u003cem\u003eChallenges with the usability and implementability of medication content in discharge summaries\u003c/em\u003e with sub-themes concentrated on key information, lack of information and usability of updated medication lists. Theme 2) \u003cem\u003eDifferent healthcare practices affect the management of medication information from discharge summaries\u003c/em\u003e in which the sub-themes were concentrated on time constraints, color coding interpretation and information load, and theme 3) \u003cem\u003eHow to tailor pharmacist-led recommendations from medication reviews\u003c/em\u003e focusing on information regarding polypharmacy and medication compliance, evidence-based information and information directed to the outpatient clinics.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights new knowledge crucial for tailoring the communication of recommendations from a clinical pharmacist: there is a need for concise medication information in discharge summaries focused on medication changes, reasons for these changes, polypharmacy, compliance and recommendations requiring GP review. Improving discharge summaries requires standardized routines, shared format understanding, and innovative technology to ensure that GPs can easily find, comprehend, and act on medication information. Moreover, exchange of medication information for outpatients were perceived challenging and needs further exploration.\u003c/p\u003e","manuscriptTitle":"Sharing of relevant medication information through discharge summaries in an acute setting – perspectives from hospital-based physicians, general practitioners and clinical pharmacists","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-10 17:59:32","doi":"10.21203/rs.3.rs-5758268/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"68226749-aea1-4c04-a820-cf5c20950999","owner":[],"postedDate":"January 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-19T04:08:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-10 17:59:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5758268","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5758268","identity":"rs-5758268","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}