ArticleBMJ open2019
Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for patients with heart failure at hospital discharge.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it, 68 citations in OpenAlex.
- Interventions for self-management of medicines for community-dwelling people with dementia and mild cognitive impairment and their family carers: a systematic review.Age and ageing · 2022Pooled it
- Trial
- Implementing a Medicines at Transitions Intervention (MaTI) for patients with heart failure: a process evaluation of the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) cluster randomised controlled trial.BMC health services research · 2024Trial
- Experiences of patients with heart failure with medicines at transition intervention: Findings from the process evaluation of the Improving the Safety and Continuity of Medicines management at Transitions of care (ISCOMAT) programme.Health expectations : an international journal of public participation in health care and health policy · 2022Trial
- Experience-based co-design-Adapting the method for a researcher-initiated study in a multi-site setting.Health expectations : an international journal of public participation in health care and health policy · 2020Trial
- Co-Design of the MAGNET Intervention to Enhance Medicines Self-Management in Community-Dwelling People With Dementia and Their Family Carers.Health expectations : an international journal of public participation in health care and health policy · 2026Article
- How Did Women From South Asian Backgrounds and People Seeking Asylum and Refugees Look After Their Health and the Health of Others During the COVID-19 Pandemic? A Community Research Approach.Health expectations : an international journal of public participation in health care and health policy · 2026Article
- Interorganisational Patient Safety Incident Reports: An Analytical Perspective.Scandinavian journal of caring sciences · 2026Article
- The feasibility of the enhancing medicines self-management for community dwelling people living with dementia and family carers (MAGNET) psychosocial intervention: protocol for a non-randomised feasibility study.Pilot and feasibility studies · 2025Article
- Exploring the complexity of safe insulin management during transfer of care using qualitative methods.Diabetic medicine : a journal of the British Diabetic Association · 2025Article
- Community pharmacists' decision-making patterns in clinical prescription checking: A simulation-based study.Exploratory research in clinical and social pharmacy · 2025Article
- Identifying Current Practices and Areas for Improvement in Medication Management During Care Transition Through an Interprofessional Collaboration Framework.Journal of multidisciplinary healthcare · 2025Article
- Dimensions of hospital resilience emphasized during the COVID-19 pandemic response: A systematic review.Health science reports · 2024Article
- Towards understanding and improving medication safety for patients with mental illness in primary care: A multimethod study.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes.BMC health services research · 2024Article
- Identifying, categorising, and mapping actors involved in resilience in healthcare: a qualitative stakeholder analysis.BMC health services research · 2024Article
- Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review.BMJ quality & safety · 2024Article
- 'It's a job to be done'. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis.Applied ergonomics · 2024Article
- Views on sharing mental health data for research purposes: qualitative analysis of interviews with people with mental illness.BMC medical ethics · 2023Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
introductionPoor medicines management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal medicines management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses.
methodsWe explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis.
resultsInterviews were conducted with 45 healthcare professionals, with 20 patients at three time points and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised medicines. Traps were features of the system that could produce errors or unintended adverse medication events. Bridges were features of the medicines management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. Props were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events.
conclusionThe numerous opportunities for HF patient safety to be compromised and for suboptimal medicines management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or 'props' put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.