Codesigning a pharmacist-led transition of care program in the emergency department: a qualitative participatory...

Transitions from the emergency department (ED) to home are high-risk periods for medication-related harm. Pharmacist-led interventions may improve medication safety and care continuity, however, co-designed approaches to developing such interventions remain limited.

This study aimed to co-design a pharmacist-led transition-of-care (ToC) program to improve medication management for adults discharged from the ED, with the intention of subsequently evaluating it in a pilot randomized controlled trial.

A two-phase qualitative study was undertaken at a general teaching hospital in Qatar within a Participatory Health Research (PHR) framework. Phase I involved one-to-one interviews and focus groups with patients, pharmacists, physicians, and nurses. Phase II consisted of a co-design workshop with decision makers, including departmental leaders and hospital administrators, followed by structured refinement through additional stakeholder meetings and an electronic prioritization survey. Data were analyzed using an inductive-deductive approach, guided by two theoretical frameworks, the Theoretical Domains Framework and the Care Transitions Framework. Five proposed interventions were evaluated against the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Safety, Equity) criteria, and identified barriers were mapped to corresponding intervention functions and implementation strategies.

Phase I, comprising three focus groups with physicians (n = 6), nurses (n = 7), and clinical pharmacists (n = 6), and four interviews with two patients and two Patient and Family Advisory Council (PFAC) representatives, identified barriers, enablers, and stakeholder priorities related to medicines management that informed the Phase II co-design workshop. Stakeholders rated the five proposed interventions: discharge medication reconciliation, prescription review, patient counseling and education, pharmacist-to-pharmacist handover, and post-discharge follow-up with medication review, as highly feasible (mean 83%). All intervention components were retained due to their interdependence. Eligibility criteria for this intervention were decided as: patients discharged with new chronic diagnoses, newly prescribed high-risk medications, polypharmacy (i.e., taking ≥ 5 regular medications), and chronic disease exacerbations. A standardized workflow was co-developed, outlining patient identification and communication. Stakeholders prioritized key intervention functions and implementation strategies via structured voting.

The pharmacist-led transition-of-care program blueprint was co-designed using a participatory, theory-informed process. The finalized program will undergo feasibility testing through a pilot randomized controlled trial and a process evaluation.