Patients’ and providers’ perceptions of the computer-generated written medication reminder for post-discharge self-management: a comparative study

doi:10.21203/rs.3.rs-4174672/v1

Background

The hospital discharge for older adults carries risks like adverse drug events. Effective patient-provider communication is crucial for post-acute care. Technology-based discharge communication tools have shown promise in improving patient experience and outcomes. However, there is limited research comparing older adult patients and health provider perspectives on a large-scale basis. In response, this study aims to evaluate a computer-generated written medication reminder by exploring and comparing patient and provider perspectives.

Method

This study comprised a cross-sectional staff survey and a before-and-after territory-wide cross-sectional patient survey. Staff who have experience with this program were all invited. Their practice situation and perceptions of the program were measured with self-administered paper-based questionnaires. Older adult patients or their caregivers were randomly selected and interviewed via telephone within 14 days of their discharge from the medical department. Their experience with medication information and the program was solicited, along with their medication-taking behaviors.

Results

A total of 1375 health providers and 2691 patients participated in the survey. From the staff side, the implementation of the program showed inconsistency, with only 56% adherence. Staff members expressed modest satisfaction with their program experiences, as indicated by mean scores ranging from 5 to 7 on a satisfaction scale of 0 to 10. On the other hand, patients reported a significant improvement in the clarity, adequacy, and usefulness of discharge medication information. Patients who received the service also reported encountering fewer self-reported side effects. When comparing the perceptions of the program, patients rated significantly higher in terms of information clarity, adequacy, usefulness, and overall experiences compared to providers.

Conclusions

Computer-generated medication reminders have potential in improving patient experience with discharge information. However, a notable disparity exists between patients and providers. This may hinder the program's benefits. Future research should explore barriers and strategies to enhance staff performance.

older adult

post-acute care

medication information

patient-provider communication

technology-based intervention

The hospital discharge process for older adult patients carries a high risk of adverse drug events (1), resulting in increased readmissions (2) and burden on the healthcare system (3). At discharge, healthcare providers play a crucial role in delivering comprehensive medication information, including side effects and warnings, to ensure the effectiveness of medication therapy for patients post-acute care. However, studies have indicated that older adult patients often lack awareness or understanding of their medication regimen after discharge home (4–6). Several factors can impede patient-provider communication, such as time constraints during the discharge process (7), limited access to resources for healthcare providers (8), and challenges posed by low patient literacy levels and language barriers (9).

Discharge communication interventions have demonstrated effectiveness in reducing readmissions and enhancing patient satisfaction, as supported by a recent meta-analysis (10). Notably, information technology-based communication practices have emerged as a prominent and preferred mode of delivering discharge information, as highlighted in literature reviews (11). Additionally, a systematic review concluded that computer-enabled discharge communication interventions improve patient or provider satisfaction and reduce perceived adverse events (12). A Cochrane review further indicated that computer-generated reminders presented on paper can enhance the quality of care (13). However, the specific effectiveness of these interventions among older adult patients remains uncertain. Furthermore, studies in these reviews evaluating technology-based discharge communication tools primarily focus on either the patient-side or provider-side, often in single institutions and predominantly conducted in Western countries. Consequently, there is a scarcity of research comparing the perspectives of older adult patients and healthcare providers on large-scale technology-based discharge communication tools within an Asian context.

In Hong Kong, the provision of discharge medication information, particularly regarding side effects and warnings, was found to be suboptimal according to a regular patient experience survey (14). In 2017, there has been a trend in integrating information technology into clinical services in Hong Kong. However, considering that older adult patients may have a higher possibility of a lack of means of accessing technologies, the Hospital Authority developed a computer-generated written medication reminder called the post-discharge information summary (PDIS) to address this issue (15). The key components of PDIS were co-designed by a multidisciplinary program team consisting of government officials, clinicians, quality and safety representatives, and technology experts. The first component includes a salient medication reminder, which is an online drug database encompassing 80% of prescribed medications for local older adult patients and featuring the most pertinent side effects and warnings. This database underwent validation through three rounds of Delphi expert consensus meetings (16). The second component comprises a list of follow-up appointments across all Hong Kong public hospitals. The PDIS system generates personalized information by integrating with the Electronic Health Record. During discharge, physicians or nurses are required to print the written summary via the PDIS system and provide it to patients or their caregivers, along with a detailed explanation of its contents, including medication side effects, warnings, and follow-up appointments.

The objective of this study is to evaluate this computer-generated written medication reminder by examining and contrasting the perspectives of both older adult patients and healthcare providers.

Study design

This study comprises a self-administered cross-sectional staff survey conducted in four public tertiary hospitals and a before-and-after territory-wide cross-sectional patient survey. Ethical approval has been approved by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee in compliance with the Declaration of Helsinki. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (17) was used to strengthen the reporting process (Appendix 1).

Setting and sampling

The study involved four public tertiary hospitals, representing three clusters within the Hospital Authority's governance of seven geographical areas. These hospitals served as pilot sites for the implementation of the PDIS. The PDIS was introduced in a phased manner within the department of medicine of the pilot hospitals starting in January 2018 (15). All physicians and nurses involved in the PDIS implementation were approached and invited to participate in the study, which took place from July to August 2018. Written consent was obtained from the participating staff members, and paper versions of the survey were distributed.

On the patient side, the sample size was decided based on the Hospital Authority's inpatient discharge statistics for patients aged 65 or above in 2015. To achieve a precision level of ± 4% at a 95% confidence level, a minimum of 1,450 respondents were required for both the pre-post surveys. Assuming a 50% response rate, at least 2,900 patients were randomly selected from the discharge records for each round of the surveys. For patients unable to respond independently, surrogate responses from caregivers were accepted. The survey excluded readmitted cases and day patients. Patients were contacted by telephone within 14 days of their discharge. The same recruitment procedure applied for both the pre and post surveys. The pre-survey was conducted from June to December 2017, and the post-survey took place from May to December 2018. Verbal consent was obtained from patients over the phone before proceeding to the telephone survey.

Data collection instrument

The staff survey encompasses three sections. The first section evaluates program fidelity, focusing on the frequency of provision and explanation, utilizing a three-level ordinal scale. The second section examines user experience, assessing agreement levels regarding various aspects of the PDIS features, usefulness, and overall satisfaction on a 0–10 scale, ranging from strongly disagree to strongly agree. Demographic information is collected in the third section.

The pre-post patient surveys consist of sections on patient experience, medication-taking behavior, and demographic information. The patient experience section draws from the validated local assessment tool known as the Short-form Hong Kong Inpatient Experience Questionnaire (SF-HKIED) (18) to standardize items related to discharge information. This section solicits patient agreement on the clarity, adequacy, and usefulness of discharge medication information, including side effects and warnings, employing a 0–10 scale from strongly disagree to strongly agree. The section on self-reported medication-taking behavior is developed based on the MMAS-4 (19) and relative studies (20). It includes two items: (1) whether they ever forgot to take their medication and (2) whether they ever experienced medication side effects, both measured by binary responses (Yes/No). Patient characteristics are collected in the final section. Furthermore, the patient post-survey includes the same question pertaining to the PDIS experience as the staff survey, facilitating comparative analysis. Both the staff and patient post-surveys also allow participants to provide free-text comments for exploration of potential avenues for improvement.

Data analysis

The statistical analysis was performed utilizing R version 4.0.5 and IBM SPSS Statistics, version 26 (IBM Corp, Armonk, NY). Consistent with the previous analysis approach for the SF-HKIEQ, questions pertaining to staff or patient experience with discharge information and PDIS were coded on a continuous scale of 0–10 or an ordinal scale of 0/5/10. The scores were then aggregated to calculate the mean and standard deviation. For the staff survey, subgroup analysis was conducted to evaluate the user experience of PDIS among physicians and nurses. The implementation behavior frequency and PDIS experiences were compared using the Chi-squared test and Mann-Whitney U test. In the patient survey, changes in patient experience regarding medication information before and after implementation were compared using the Mann-Whitney U test. The self-reported encounters with medication side effects and compliance were assessed using the Chi-square test. To explore any discrepancies between healthcare providers and patients, the shared questions related to PDIS experience in the staff and patient post-surveys were compared using the Mann-Whitney U test. Thematic analysis (21) was conducted on the free-text comments aimed to identify and explore common themes and patterns within the comments.

Staff survey

The staff survey received a total of 1,375 responses, comprising 28% (n = 384) male and 72% (n = 966) female participants. The majority of respondents fell within the younger age group of 18–29 years (n = 650, 50%), and a significant proportion had 0–5 years of working experience (n = 595, 50%). Among the staff survey participants, doctors accounted for 12% (n = 159), while the remaining 88% were nurses (n = 1,216) (Table 1).

Table 1

Demographic information of healthcare professionals
Characteristics	Total N = 1375
Gender, n (%)	1348 (98)
Female	966 (72)
Male	382 (28)
Age, n (%)	1296 (94.3)
18–29	650 (50)
30–39	349 (27)
40–49	206 (16)
50–59	86 (6.6)
>60	5 (0.4)
Professional role	1375 (100)
Physicians	159 (12)
Nurses	1216 (88)
Working experience, n (%)	1180 (85.8)
0–5	595 (50)
6–10	278 (24)
11–15	94 (8.0)
16–20	125 (11)
20–25	42 (3.6)
26–30	37 (3.1)
>31	9 (0.8)

Analysis of the practice situation (Table 2) revealed that 72.1% (n = 922) of the staff reported being able to consistently provide the PDIS to patients or caregivers, whereas only 56% (n = 667) stated they could consistently explain its content. Subgroup analysis demonstrated significant practice variations across different professional roles. In terms of PDIS provision, 78% (n = 915) of nurses reported always providing the PDIS, while only 6.4% (n = 7) of doctors reported doing so (P < .001). Similarly, with regard to PDIS explanation, 57% (n = 666) of nurses reported always explaining the content, compared to only 3.8% (n = 1) of doctors (P < .001).

Table 2

Staff implementation behaviors and perceptions of the PDIS
Items	Total N = 1375	Physicians N = 159	Nurses N = 1216	P value*
PDIS implementation behavior, n(%)
Provision of PDIS	1234 (89.7)	109 (68.6)	1170 (96.2)	< 0.001
Always	922 (72)	7 (6.4)	915 (78)
Sometimes	261 (20)	17 (16)	244 (21)
Never	96 (7.5)	85 (78)	11 (0.9)
Explanation of PDIS	1190 (86.5)	26 (16.4)	1164 (95.7)	< 0.001
Always	667 (56)	1 (3.8)	666 (57)
Sometimes	475 (40)	11 (42)	464 (40)
Never	48 (4.0)	14 (54)	34 (2.9)
Perceptions of PDIS experiences, Mean (SD)
PDIS information is clear	6.54 (1.86)	6.50 (1.61)	6.54 (1.86)	0.670
PDIS information is adequate	6.14 (2.07)	6.24 (1.61)	6.14 (2.08)	0.930
PDIS information is useful for patients/ careers	6.50 (2.02)	6.69 (1.81)	6.50 (2.02)	0.702
PDIS supports my medication instruction to patients/ careers	6.35 (2.07)	6.08 (1.81)	6.36 (2.07)	0.322
Patient-provider communication becomes more effective with PDIS	6.21 (2.05)	6.00 (1.55)	6.21 (2.06)	0.344
PDIS enhances my job efficiency	5.97 (2.20)	6.08 (1.72)	5.97 (2.21)	0.825
PDIS is useful in my job	6.03 (2.16)	6.12 (1.68)	6.02 (2.17)	0.971
PDIS increases my workload	5.98 (2.21)	5.35 (2.15)	6.00 (2.21)	0.136
I am willing to use PDIS	6.09 (2.18)	6.12 (1.63)	6.09 (2.19)	0.722
I will recommend PDIS to my colleague	5.95 (2.19)	6.08 (1.73)	5.95 (2.20)	0.897
Overall rating of PDIS utilization experiences	6.29 (1.88)	6.56 (1.51)	6.28 (1.88)	0.750
*: P-value was obtained from the Chi-squared test and Mann-Whitney U test

Regarding user experience, the findings indicated moderate satisfaction with the various aspects of the PDIS, including its information clarity (Mean = 6.54 ± 1.86), information adequacy (Mean = 6.14 ± 2.07), information usefulness to patients or caregivers (Mean = 6.50 ± 2.02), perceived usefulness in their work (Mean = 6.03 ± 2.16), and overall experience (Mean = 6.29 ± 1.88) as reflected by mean agreement scores ranging between 5.96 and 6.54 (Table 2). Interestingly, despite the significant practice variations observed among professional roles, the subgroup analysis did not identify any differences between physicians and nurses in terms of user experiences.

Patient survey

A total of 2,691 responses were received, including 1,265 (47%) and 1,426 (53%) responses collected via the pre-post surveys, respectively. The response rate was 55.5% for the pre-survey and 59.4% for the post-survey. The demographic composition was similar between the pre-post survey groups in terms of age, gender, education level, living and employment status, and the number of complications, except that 6.6% more participants were receiving the government subsidy in the post-survey group (P < .001) (Table 3).

Table 3

Demographic information of participants between pre-post survey groups
Characteristics	Total N = 2691	Pre-survey N = 1265	Post-survey N = 1426	P Value*
Age, Mean (SD)	77.48 (7.98)	77.37 (8.01)	77.58 (7.96)	0.487
Gender, n (%)				0.445
Female	1215 (45.2)	581 (45.9)	634 (44.5)
Male	1476 (54.8)	684 (54.1)	792 (55.5)
Education, n (%) ^a				0.161
≤ High school	2455 (91.2)	1168 (92.3)	1287 (90.3)
College	71 (2.6)	29 (2.3)	42 (3.0)
≥ College	131 (4.9)	53 (4.2)	78 (5.5)
Living status, n (%) ^b				0.722
Living alone	340 (12.6)	166 (13.1)	174 (12.2)
Living with companions	2339 (86.9)	1098 (86.8)	1241 (87.0)
Living in institutions	3 (0.1)	1 (0.1)	2 (0.1)
Employment status, n (%) ^c				0.057
Unemployed	2601 (96.7)	1217 (96.2)	1384 (97.1)
Employed	78 (2.9)	45 (3.6)	33 (2.3)
Government subsidy, n(%) ^d				< 0.001
Yes	2143 (79.6)	969 (76.6)	1174 (82.3)
No	548 (20.4)	296 (23.4)	252 (17.7)
*Number of complications, Mean (SD)** ^e	1.48 (1.06)	1.49 (1.06)	1.47 (1.06)	0.622
*: Complications including deaf, blindness, physical disability, learning disability, mental health disorders, heart disease, hypertension, diabetes, cancer
*: P-value was obtained from the independent sample t-test or Chi-squared test.
There are ^a: 34, ^b: 9, ^c: 12, ^d: 21, and ^e: 22 missing values excluded from the analysis.

The pre-post patient survey analysis revealed significant improvements in patient experience related to the clarity, adequacy, and usefulness of discharge medication information after the introduction of PDIS (Table 4). Specifically, the post-survey group demonstrated higher ratings for clarity (8.18 ± 1.69 vs. 7.93 ± 1.84, respectively, P = .002), adequacy (8.15 ± 1.76 vs. 7.92 ± 1.93, respectively, P = .01), and usefulness (8.26 ± 1.70 vs. 8.06 ± 1.80, respectively, P = .02) of the provided information. Regarding side effects and warnings, the post-survey group exhibited a significant increase in information adequately for both side effects (9.6 ± 2.0 vs. 8.6 ± 3.4, respectively, P < .001) and warnings (9.7 ± 1.8 vs. 9.2 ± 2.7, respectively, P = .004). In terms of information clarity, although a higher rating in the post-survey group for both side effects and warning signs, only warnings reached statistical significance (8.77 ± 2.32 vs. 8.45 ± 2.45, respectively, P = .03). Furthermore, the post-survey group reported a significantly higher rating on usefulness for warnings (8.7 ± 2.45 vs. 8.44 ± 2.39, respectively, P = .03), while the increase in rating for side effects did not reach statistical significance.

Table 4

Comparison of the patient or caregivers’ perceptions of discharge medication information and medication taken behavior between pre-post survey groups
Items	Total N = 2691	Pre-test N = 1265	Post-test N = 1426	P Value*
Perspectives of the Information on discharge medication information
Clarity, Mean (SD)
Overall	8.06 (1.77)	7.93 (1.84)	8.18 (1.69)	0.003
Side effects	8.47 (2.50)	8.31 (2.63)	8.60 (2.39)	0.101
Warning signs	8.61 (2.39)	8.45 (2.45)	8.77 (2.32)	0.026
Adequacy, Mean (SD)
Overall	8.04 (1.85)	7.92 (1.93)	8.15 (1.76)	0.018
Side effects	9.2 (2.8)	8.6 (3.4)	9.6 (2.0)	< 0.001
Warning signs	9.4 (2.3)	9.2 (2.7)	9.7 (1.8)	0.004
Usefulness, Mean (SD)
Overall	8.17 (1.75)	8.06 (1.80)	8.26 (1.70)	0.012
Side effects	8.47 (2.46)	8.34 (2.51)	8.57 (2.42)	0.115
Warning signs	8.57 (2.42)	8.44 (2.39)	8.70 (2.45)	0.033
Medication-taking Behaviors
Self-reported side effects encounter, n (%)	2318 (86.1)	1083 (85.6)	1235 (86.6)	0.036
Yes	237 (10.2)	126 (11.6)	111 (9.0)
No	2081 (89.8)	957 (88.4)	1124 (91.0)
Self-reported medication compliance, n (%)	2326 (86.4)	1086 (85.8)	1240 (87.0)	0.385
Yes	2227 (95.7)	1044 (96.1)	1183 (95.4)
No	99 (4.3)	42 (3.9)	57 (4.6)
*: P-value was obtained from the Mann-Whitney U test and Chi-squared test

There was no significant statistical difference observed in the percentage of patients reporting medication compliance when comparing the pre- and post-survey groups. Additionally, it is worth noting that the post-survey group exhibited a significantly lower percentage of individuals reporting experiences of side effects (9.0% vs. 11.6%, P = .04). This finding suggests that receiving risk information may not lead to an increase in side effects experiences but rather a reduction in such experiences among older adult patients. Among participants who reported encounters with side effects, the majority of them (86.4%) demonstrated compliance with medication instructions.

Comparative analysis

The comparative analysis of staff and patient surveys exhibited statistically significant differences in mean ratings (Fig. 1). Patients consistently provided significantly higher ratings for their overall PDIS experience compared to the staff (8.28 ± 1.60 vs. 6.29 ± 1.88, respectively, P < .001). Specifically, patients reported higher ratings for the clarity of the information provided within PDIS (8.58 ± 2.50 vs. 6.54 ± 1.86, respectively, P < .001). They also expressed a greater perception of the usefulness of PDIS to their needs (8.14 ± 2.46 vs. 6.50 ± 2.02, respectively, P < .001). On the contrary, patients expressed a preference for receiving more information through PDIS (5.33 ± 1.35 vs. 6.14 ± 2.08, respectively, P < .001).

This study aimed to examine and compare the perceptions of older adult patients and healthcare providers regarding the utilization of computer-generated written medication reminders as a means of communicating medication information for post-discharge self-management. The findings of this study revealed that healthcare providers expressed moderate satisfaction with the implementation of this technology-based communication tool, particularly in terms of its information clarity and adequacy, usefulness to patients and daily work, and overall experiences. However, the results indicated that patients who received the written summary reported an improved perception of information adequacy regarding side effects and warnings compared to patients who did not receive this service. Furthermore, there was a significant improvement in the perceived clarity and usefulness of information on warnings among patients who received the services. When comparing the ratings of this service, a notable discrepancy emerged between patients and healthcare providers. Older adult patients tended to provide higher ratings in terms of information clarity, usefulness of the service, and overall experience compared to providers. However, they expressed a desire for more information to be provided by PDIS than providers.

When examining the ratings regarding the amount of information provided through this service, patients consistently assigned significantly lower scores compared to providers. This finding may be attributed to the PDIS database design directed by healthcare providers, who often refrain from providing as much information as patients desire, as they may have concerns regarding the potential negative consequences of sharing information on side effects. Such concerns include the possibility of overwhelming patients with excessive information, which could lead to anxiety and non-compliance (22–24). However, our study did not find evidence supporting the notion that providing such information negatively impacts patient compliance, which aligns with the findings of other studies (25). Nonetheless, the improved rating of overall medication information adequacy from the perspective of patients may suggest that the information gap regarding medication side effects has been narrowed through the provision of these services. Previous studies have proposed a potential strategy of providing information on medication effects and benefits, alongside side effects, in order to counterbalance the potential negative impact of risk information (26, 27).

This study did not observe any evidence indicating an improvement in the clarity of information regarding side effects and warnings among older adult patients who received the service. This finding can be partly attributed to the characteristic of the older adult population, which is known to have relatively low health literacy levels, thus potentially impacting their understanding of medication risk information (28, 29). In comparison to patients, staff members assigned significantly lower scores in terms of the clarity of information provided through PDIS. This discrepancy may also be explained by the staff's awareness of the challenges related to the health literacy of older adults, as suggested by a previous study (30). Previous research has demonstrated that employing strategies such as utilizing lay language, employing shorter sentences, and providing visual aids alongside verbal descriptions of side effects can assist patients in comprehending the level of risk (31).

This study has obtained evidence suggesting that the usefulness of information has improved among older patients who received this service, and patients assigned a higher rating to this aspect compared to providers. A previous systematic review concluded that patients perceived written medication information as valuable when making decisions regarding the necessity of seeking professional assistance (32). This empowerment enables patients to take responsibility for their own care. The relatively lower rating of usefulness from the provider's perspective could be explained by considerations of the credibility of the sources providing medication risk information. Prior research suggests that physicians prefer to prioritize side effects based on their own judgment and may not consider written information as more effective than counseling (33). It has been suggested that relying solely on written information about medication side effects may be insufficient. Combining the use of PDIS with counseling services could have a synergistic effect, enhancing the effectiveness of information transmission (34–36). Employing multidisciplinary coordination involving physicians, nurses, and pharmacists could facilitate the more appropriate management of medication risk communication (33).

A significant enhancement in satisfaction with discharge medication information was identified among older adult patients who utilized the service. This finding aligns with previous studies that have reported similar results (37, 38). However, caution must be exercised when interpreting this outcome, as older adults tend to exhibit higher satisfaction levels with the medication information they receive compared to younger individuals (39). This may be attributed to the fact that older adults are often in a culture where the authority of providers is less challenged (40). It is important to note that the high satisfaction rating might obscure potential unmet individual preferences. Prior research has advocated for the provision of personalized information regarding medication side effects (41). However, delivering information tailored to each patient's specific needs may not always be feasible in a clinical setting. Future studies should be conducted to explore how to strike a balance between work efficiency and meeting patient needs when delivering such services. Additionally, our findings indicate that older adult patients assigned significantly higher ratings to the overall experience of this service compared to healthcare providers. This observation can be inferred from the relatively higher ratings in terms of information adequacy, clarity, and usefulness. Qualitative comments revealed that negative opinions were more frequently expressed by healthcare providers, particularly regarding the design of the PDIS system, such as its user-friendliness and information quality, which is consistent with findings from other studies (42–44). Furthermore, our study identified additional aspects, including concerns about environmental friendliness, duplication with other discharge documents, and the absence of a patient follow-up plan.

This study possesses several notable strengths. To the best of our knowledge, it is the first study to examine and compare the perceptions of older adult patients and healthcare providers regarding the utilization of large-scale technology-based discharge communication tools. This valuable contribution enriches the existing evidence base concerning the advantages associated with computer-generated written medication reminders for discharge education. Furthermore, the recruitment of a study sample from multiple hospitals across a wide geographic area underscores the robustness and generalizability of our findings. This study has several limitations that should be acknowledged. Firstly, the reliance on self-reported survey data introduces the possibility of inaccuracies due to social desirability bias. However, by including participants from diverse backgrounds, we aimed to mitigate this limitation to some extent. Secondly, our study did not incorporate patient outcomes as a common metric for evaluating the effectiveness of the program because our primary objective was to explore and compare the experiences of patients and staff regarding the utilization of technology-based communication tools. Given the positive experiences reported by patients, future studies could be conducted to investigate the clinical outcomes in order to enrich the evidence base. Lastly, the cross-sectional design employed in this study limits our ability to establish causal inferences regarding the factors that potentially influence staff's inconsistent use of the PDIS. Subsequent studies utilizing longitudinal or experimental designs are warranted to explore the causal mechanism underlying variations in staff behavior and to design effective strategies that can enhance their performance.

The findings of this study suggest that the utilization of computer-generated medication reminders holds promise in enhancing the patient experience with discharge information. However, there exists a notable disparity between patients and providers regarding the adequacy, clarity, and usefulness of medication side effects and warnings, which may hinder the full realization of the program's benefits for patients. These findings have implications for future research, particularly in the realm of implementation research, where investigations into potential barriers and the design of strategies to enhance staff performance can be explored. Moreover, this study offers valuable insights for organizations aiming to enhance post-acute care for older adult patients during hospitalization, particularly those interested in technology-based interventions.

Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-7.
Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, et al.Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211-8.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-28.
Davis TC, Wolf MS, Bass PF, 3rd, Thompson JA, Tilson HH, Neuberger M, et al.Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887-94.
Sanderson BK, Thompson J, Brown TM, Tucker MJ, Bittner V. Assessing patient recall of discharge instructions for acute myocardial infarction. J Healthc Qual. 2009;31(6):25-33; quiz 4.
Wolf MS, Davis TC, Shrank W, Rapp DN, Bass PF, Connor UM, et al.To err is human: patient misinterpretations of prescription drug label instructions. Patient Educ Couns. 2007;67(3):293-300.
Chugh A, Williams MV, Grigsby J, Coleman EA. Better transitions: improving comprehension of discharge instructions. Front Health Serv Manage. 2009;25(3):11-32.
Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA. Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews. J Med Internet Res. 2017;19(4):e122.
Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219-22.
Becker C, Zumbrunn S, Beck K, Vincent A, Loretz N, Müller J, et al.Interventions to improve communication at hospital discharge and rates of readmission: a systematic review and meta-analysis. JAMA Network Open. 2021;4(8):e2119346-e.
Newnham H, Barker A, Ritchie E, Hitchcock K, Gibbs H, Holton S. Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review. Int J Qual Health Care. 2017;29(6):752-68.
Motamedi SM, Posadas-Calleja J, Straus S, Bates DW, Lorenzetti DL, Baylis B, et al.The efficacy of computer-enabled discharge communication interventions: a systematic review. BMJ Qual Saf. 2011;20(5):403-15.
Arditi C, Rège-Walther M, Wyatt JC, Durieux P, Burnand B. Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2012;12:Cd001175.
Wong EL, Coulter A, Cheung AW, Yam CH, Yeoh EK, Griffiths SM. Patient experiences with public hospital care: first benchmark survey in Hong Kong. Hong Kong Med J. 2012;18(5):371-80.
Wong EL, Tang KS, Dong D, Mo PK, Cheung AW, Lau JC, et al.Evaluation of the implementation of information system for postdischarge with the theoretical domains framework by healthcare professionals: a multistage design with qualitative inquiry and Delphi expert discussion protocol. BMJ Open. 2021;11(12):e046081.
Wong EL, Tang KS, Cheung AW, Sze RK, Lau JC, Mok FC, et al.Development of salient medication reminders to facilitate information transfer during transition from inpatient to primary care: the Delphi process. BMJ Open. 2021;11(5):e041336.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bmj. 2007;335(7624):806-8.
Wong EL, Coulter A, Hewitson P, Cheung AW, Yam CH, Lui SF, et al.Patient experience and satisfaction with inpatient service: development of short form survey instrument measuring the core aspect of inpatient experience. PLoS One. 2015;10(4):e0122299.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
McConachie SM, Berri D, Konja J, Giuliano CA. Evaluation of adverse drug reaction formatting in drug information mobile phone applications. J Med Libr Assoc. 2022;110(1):81-6.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88.
Curtis LM, Mullen RJ, Russell A, Fata A, Bailey SC, Makoul G, et al.An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: The role of written and spoken communication. Patient Educ Couns. 2016;99(9):1489-95.
McGrath JM. Physicians' perspectives on communicating prescription drug information. Qual Health Res. 1999;9(6):731-45.
Tarn DM, Wenger A, Good JS, Hoffing M, Scherger JE, Wenger NS. Do physicians communicate the adverse effects of medications that older patients want to hear? Drugs Ther Perspect. 2015;31(2):68-76.
Howland JS, Baker MG, Poe T. Does patient education cause side effects? A controlled trial. J Fam Pract. 1990;31(1):62-4.
Längst G, Seidling HM, Stützle M, Ose D, Baudendistel I, Szecsenyi J, et al.Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals. Patient Prefer Adherence. 2015;9:1431-41.
Hamrosi KK, Raynor DK, Aslani P. Pharmacist, general practitioner and consumer use of written medicine information in Australia: are they on the same page? Res Social Adm Pharm. 2014;10(4):656-68.
Davis TC, Wolf MS, Bass PF, 3rd, Middlebrooks M, Kennen E, Baker DW, et al.Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006;21(8):847-51.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
Shin DW, Roter DL, Cho J, Kim SY, Yang HK, Suh B, et al.Attitudes toward disclosure of medication side effects: a nationwide survey of Korean patients, caregivers, and oncologists. Psychooncology. 2015;24(11):1398-406.
McCormack L, Craig Lefebvre R, Bann C, Taylor O, Rausch P. Consumer Understanding, Preferences, and Responses to Different Versions of Drug Safety Messages in the United States: A Randomized Controlled Trial. Drug Saf. 2016;39(2):171-84.
Grime J, Blenkinsopp A, Raynor DK, Pollock K, Knapp P. The role and value of written information for patients about individual medicines: a systematic review. Health Expect. 2007;10(3):286-98.
Tarn DM, Paterniti DA, Williams BR, Cipri CS, Wenger NS. Which providers should communicate which critical information about a new medication? Patient, pharmacist, and physician perspectives. J Am Geriatr Soc. 2009;57(3):462-9.
Schmitt MR, Miller MJ, Harrison DL, Farmer KC, Allison JJ, Cobaugh DJ, et al.Communicating non-steroidal anti-inflammatory drug risks: verbal counseling, written medicine information, and patients' risk awareness. Patient Educ Couns. 2011;83(3):391-7.
Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, et al.A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess. 2007;11(5):iii, 1-160.
Koo MM, Krass I, Aslani P. Factors influencing consumer use of written drug information. Ann Pharmacother. 2003;37(2):259-67.
Gillam SW, Gillam AR, Casler TL, Curcio K. Education for medications and side effects: a two part mechanism for improving the patient experience. Appl Nurs Res. 2016;31:72-8.
Jones TR, Coke L. Impact of Standardized New Medication Education Program on Postdischarge Patients' Knowledge and Satisfaction. J Nurs Adm. 2016;46(10):535-40.
van Geffen EC, Philbert D, van Boheemen C, van Dijk L, Bos MB, Bouvy ML. Patients' satisfaction with information and experiences with counseling on cardiovascular medication received at the pharmacy. Patient Educ Couns. 2011;83(3):303-9.
Sze WT, Pudney R, Wei L. Inpatients' satisfaction towards information received about medicines. Eur J Hosp Pharm. 2020;27(5):280-5.
Kusch MK, Haefeli WE, Seidling HM. How to meet patients' individual needs for drug information - a scoping review. Patient Prefer Adherence. 2018;12:2339-55.
Ferdousi R, Arab-Zozani M, Tahamtan I, Rezaei-Hachesu P, Dehghani M. Attitudes of nurses towards clinical information systems: a systematic review and meta-analysis. Int Nurs Rev. 2021;68(1):59-66.
Moore EC, Tolley CL, Bates DW, Slight SP. A systematic review of the impact of health information technology on nurses' time. J Am Med Inform Assoc. 2020;27(5):798-807.
Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, et al.Barriers and facilitators to utilizing digital health technologies by healthcare professionals. npj Digital Medicine. 2023;6(1):161.

Appendix 1 is not available with this version.

The authors declare no competing interests.

Patients’ and providers’ perceptions of the computer-generated written medication reminder for post-discharge self-management: a comparative study

Status:

Version 1

Abstract

Background

Method

Results

Conclusions

Figures

Background

Methods

Study design

Setting and sampling

Data collection instrument

Data analysis

Results

Staff survey

Patient survey

Comparative analysis

Discussions

Conclusions

References

Appendix

Additional Declarations

Status:

Version 1