Better integration and coordination between primary and secondary care, including undertaking medicines reconciliation, will improve medication support during and after hospital discharge for people with chronic obstructive pulmonary disease (COPD), new research suggests.
COPD patients frequently encounter challenges with their medications, such as non-adherence to medicines and incorrect use of inhalers, which can lead to readmission and poor outcomes.
Understanding the context of these challenges and addressing barriers to optimal care delivery can be beneficial before any new interventions are implemented. As such, an research team aimed to identify areas in which medicines support could be improved during and after hospital discharge.
The researchers interviewed hospital pulmonary ward staff at a university hospital in Norway between December 2023 and February 2024, conducting focus groups with nurses and nursing assistants working on the pulmonary inpatient ward and semi-structured interviews with doctors working on the inpatient or outpatient pulmonary ward.
Through systematic text condensation, the researchers identified six key themes and categorised them as organisational-level and practitioner-level issues.
Identifying organisational-related challenges in COPD
At an organisational level, staff found transferring patients from secondary to primary care challenging, especially when there was no clear overview of services available for discharged patients in different areas.
Staff reported that medicine lists were not always updated by hospital physicians; medicine reconciliation was not always completed in primary care, sometimes leading to avoidable medication errors; and the interoperability of electronic health record (EHR) systems across different care settings did not function effectively.
The responsibility of post-discharge follow-up and patient education on medicine use was often not clearly delegated to pulmonary rehabilitation, general practice or pharmacy. In outpatient clinics, staff experienced time pressures that meant individualised education and training on medicines was not always possible.
Additionally, disparities in financial resources among primary care providers contributed to organisational-level issues, leading to inconsistent access to rehabilitation services and a lack of understanding from hospital staff about ‘what awaits the patient when they are discharged’.
Practitioner level challenges
At the practitioner level, the three themes that emerged included competence around COPD resources for rehabilitation, clarification of professional roles and task distribution, and the need for practitioners to educate and support patients.
Staff reported a significant knowledge gap regarding inhalers and medical devices within non-specialised healthcare settings, including general hospital wards and intermediate care units, as well as home care services, which could lead to longer hospital stays. A proposed solution was for hospital staff or pharmacists to provide training for home care staff to mitigate this risk.
In primary care, general practitioners were found to be reluctant to modify hospital-initiated medicines, but hospital staff noted that pharmacists could detect errors in prescribing and undertake medicines reconciliation.
Additionally, staff agreed that more time needs to be spent educating patients on the proper use of inhalers, with structured discharge consultations being one suggestion for achieving this. Hospital pharmacy was also highlighted as a suitable place for inhaler training away from busy wards.
The researchers concluded that improving medicines support for patients with COPD requires better coordination and integration across all care levels, with increased support and education for healthcare workers in both primary and secondary care. They added that medicine reconciliation should be undertaken to ensure that updated medicine lists are used across care levels.
Future research should include more than one hospital and the views of community pharmacists, general practitioners and nursing staff, the researchers noted.
Reference Nygård T et al. Providing medicines-related support for people with COPD before and after hospital discharge—a qualitative study of hospital staff perspectives. BMC Health Serv Res 2025;25(1):899.
