ENgaginG older people Across transitions of care to improve medication manaGEment – Developing and Testing Co-designed Strategies

Feedback events and co-design group workshops will be conducted to develop strategies aimed at optimising medication management with older people across transitions of care. Feedback events are group or individual interviews conducted with health professionals, patients and families. Either a researcher or PhD student will conduct the individual interviews, while two individuals comprising a combination of researchers or PhD students, are likely to be involved in the conduct of group interviews. Group interviews will involve patients or families in conversations, or health professionals in conversations. These participants will identify possible engagement strategies that can be used in actual practice. Included hospitals for feedback events are the Monash Medical Centre, Dandenong Hospital, Casey Hospital, and Kingston Centre. About 120 individuals will participate in feedback events. For each hospital, about 10 patients, 10 family members and 10 health professionals will participate. The actual number recruited will depend on demographic makeup of individuals and the need to ensure diverse views are obtained. These sessions will occur face to face or online. Individual or group interviews will be about 30 minutes in duration. Co-design group panels will be conducted with health professionals, patients and families together to prioritise strategies identified from feedback events, and to devise practical ways in how strategies are implemented. Included hospitals for co-design panels, are the Monash Medical Centre, Dandenong Hospital, Casey Hospital, and Kingston Centre. About 72 individuals will participate in co-design panels, with about 6 patients, about 6 family members or advocates, and about 6 health professionals will participate in each co-design panel. It is anticipated there will be about one co-design panel for each hospital. Each panel will meet about 1-2 times for about 60-90 minutes. The actual number of meetings and the duration involved will be determined by the panel members themselves. These panels will be conducted face to face, online or a mixture of the two approaches. While it is possible for participants in the feedback events will be also participating in co-design panels, the aim is to have a wide diversity of individuals taking part. For the purpose of feedback sessions and co-design workshops, patients and their families may also be recruited through Monash Health's consumer advisory groups or registers. Patients and their families may also be recruited from consumer health organisations, such as the Australian Patients Association. A feasibility and acceptability trial will be undertaken using strategies developed from feedback events and co-design panels. Included hospitals for the conduct of the feasibility and acceptability trial are wards from wards at either Monash Medical Centre, or Dandenong Hospital or Casey Hospital, or Kingston Centre. About 20 intervention patients and 20 usual care patients will participate in each of the two hospitals. In addition, about 20 family members, and 20 health professionals will participate in feasibility and acceptability testing. In all, about 80 individuals will participate in the feasibility and acceptability trial, which will include patients, family members and health professionals. The intervention will be delivered to patients during their hospitalisation. All patients will receive usual care in relation to their hospitalisation. For patients randomised to the intervention group, they will also receive the intervention during the same time period. The intervention will focus on three key types of strategies: information seeking, decision-making, and managing medications. The information seeking type of strategy will include giving patients a list of questions developed from the co-design groups about seeking information relating to their medications. This information will relate the purpose of their medications, how to take their medications, how the medications work and what side effects they produce. The decision making type of strategy will comprise providing patients and families with questions to query why the medications are needed, especially if changes have been made, and if any alternative treatments can be used instead, such as non-medication treatments. The managing medications type of strategy will focus on helping patients to understand and to carry out their medication regimens. Depending on the co-design panels, patients will be provided with medication management applications (apps), and practical prompts to use in assisting with medication-taking activities. One of the researchers will deliver the intervention to patients. This researcher will provide patients with details about the intervention following recruitment and consent. Patients in the intervention group will be able to contact this researcher if they have any queries arising from using the strategies of the intervention, such as issues they may have in accessing the materials. This researcher will periodically remind each patient about using the strategies. Another researcher will check at hospital discharge about the proportion of patients who state that they referred to the strategies underpinning the intervention.