Realist review of informal carer involvement in the transition of medicines-related care for patients moving from hospital to home

Objective
The aim of this work was to understand carer involvement in transitions of care from hospital to home in relation to medicines management. Specifically, via a realist review, to describe how carers provide support, to what extent do they support patients, and under what circumstances are carers able to provide support towards patient care in relation to medicines management.
Design
A realist review was conducted in line with a published protocol and as registered via PROSPERO (CRD42021262827). An initial programme theory (PT) was developed before searches of three databases, PubMed, CINHAL and EMBASE, were conducted in accordance with eligibility criteria. Data were extracted from eligible studies and synthesised into realist causal explanations in the form of Context-Mechanism-Outcome configurations (CMOCs) and the PT was refined. Throughout the review, a patient and public involvement and engagement group (N≥5 who met five times) were involved to inform the research focus, and develop CMOCs and the PT by providing feedback and ensuring they capture the carer experience.
Results
Following title and abstract screening of 4835 papers, the final number of included articles was 208. The evidence synthesis identified 31 CMOCs which were categorised into three themes: (i) continuum of support; (ii) understanding the carers’ priorities, role and responsibilities through shared decision-making (SDM); and (iii) access to appropriate materials, resources and support information. These themes were formed into an updated PT with accompanying narrative, that explained the transition from hospital to home involving carers in medicines management, and identified possible areas for future intervention development.
Conclusion
This review provides insights and recommendations on how carers can be better supported when managing medicines when patients are discharged from hospital. Carers need a continuum of support throughout and following the transition. Health care professionals can support this by understanding the carer’s priorities, role and responsibilities through SDM during the hospital stay. Consequently, carers can then be offered access to appropriate materials, resources and support information which allows them to provide better care relating to medicines in the long term.