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• Glatkauskas, Mikas; Syversen, Malin Olsen; Mathiesen, Liv; Scott, Michael; Svensberg, Karin & Denstad, Berit Gallefoss [Show all 7 contributors for this article] (2026). Perspectives on shared decision making related to medications from patients with multiple long-term conditions transitioning from hospital to home: a qualitative study. International Journal of Clinical Pharmacy. ISSN 2210-7703. doi: 10.1007/s11096-026-02143-x. Full text in Research Archive Show summary

  Introduction Shared decision making is particularly important for patients with multiple long-term conditions due to the nature of long-term treatments and frequent changes in medication regimens. However, the complexity of the medication regimens could exclude these vulnerable patients from shared decision making. There is little knowledge about how patients with multiple long-term conditions experience and perceive shared decision making. Aim The aim was to explore the perspectives and experiences of patients with multiple long-term conditions regarding shared decision making related to medications before, during and after a hospital stay. Method Semi-structured interviews with 21 patients and three next of kin were conducted. Patients ≥ 18 years, usually living at home, on at least four medications for at least two separate conditions were included. These patients were purposively sampled from two geriatric wards and one internal medicine ward at a university hospital in Norway and interviewed approximately 14 days post hospital discharge. The inclusion and interviews lasted from December 2022 to February 2024. A semi-structured interview guide was used, and the qualitative data were analyzed using directed content analysis guided by the three-talk model developed by Elwyn et al. from 2017. Results Patients reported not being invited to be part of the shared decision-making process and perceived their limited medical knowledge as a barrier to being invited to participate. They reflected on themselves being primarily focused on single details regarding one medication option they had received. Furthermore, they were not encouraged by the healthcare professionals to discuss and compare different medication options. Both patients and next of kin described an expectation that decisions being made by healthcare professionals would be accepted although the patient did not necessarily understand the treatment plan adequately. Several patients reported that healthcare professional led decisions left little to no room for further discussion and that medication decisions and patient health goals were almost solely in the hands of the healthcare professional. Although most patients trusted the healthcare professional to act in their best interests, this reliance resulted in further disengagement from their own treatment. Conclusion Patients with multiple long-term conditions were in general unfamiliar with and uninvolved in shared decision making related to medications. Additionally, the patients reflected on a lack of invitation to team talk which resulted in limited patient involvement both in option and decision talk.

• Syversen, Malin Olsen; Glatkauskas, Mikas; Mathiesen, Liv; Lea, Marianne; Denstad, Berit Gallefoss & Svensberg, Karin (2025). Facilitators and barriers to medication self-management for patients with multiple long-term conditions transitioning from hospital to home. Exploratory Research in Clinical and Social Pharmacy (ERCSP). 18. doi: 10.1016/j.rcsop.2025.100598. Full text in Research Archive
• Glatkauskas, Mikas; Syversen, Malin Olsen; Lea, Marianne; Scott, Michael; Svensberg, Karin & Denstad, Berit G. [Show all 8 contributors for this article] (2025). Application of a human factors approach to investigate the hospital to home transition for patients with multiple long-term conditions. Human Factors in Healthcare (HFH). 7. doi: 10.1016/j.hfh.2025.100100. Full text in Research Archive
• Syversen, Malin Olsen; Glatkauskas, Mikas; Sedeniussen, Sandra Johanne; Hauge, Monica; Benny, Steffi & Horgen, Kristine [Show all 12 contributors for this article] (2025). Discrepancies in medication lists after hospital discharge in patients with multiple long-term conditions. Research in Social and Administrative Pharmacy. ISSN 1551-7411. 21(8), p. 580–588. doi: 10.1016/j.sapharm.2025.03.062. Full text in Research Archive Show summary

  Background Inadequate information flow in the transition from hospital to home poses a challenge to medication safety, especially for patients with multiple long-term conditions (MLTCs). Purpose To investigate the frequency, categories, underlying reasons, and potential clinical relevance of medication discrepancies (MDs) by comparing medication lists in hospital discharge summaries with actual medication use after discharge in patients with MLTCs. Methods Home-dwelling adult patients with MLTCs, using minimum four medications were included near the time of their planned discharge, from one internal medicine and two geriatric wards in Oslo, to this cross-sectional observational study. Medication reconciliation was performed 1–2 weeks post-discharge. Discrepancies between the medication list in the discharge summary and the patient's medication use were classified into six categories. A panel assessed the potential clinical relevance of the MDs in a short-term and long-term perspective. Results 150 patients, median age 75 years (range 22–94), were included. 132 (88 %) had at least one MD, with a median of 3 per patient (range 0–10). The most common MDs involved medications in use although not listed in the discharge summary. Apparent lack of or insufficient medication reconciliation during the hospital stay was the most frequent reason for MDs. Of the MDs, 5.5 % and 28 % were assessed to be of potential clinical relevance in the short-term and long-term perspective, respectively. Conclusion Almost all patients had MDs following hospital discharge. The potential clinical relevance increases over time if MDs are not corrected. Our findings highlight the need for more effective interventions to ensure medication safety in care transitions for this vulnerable population.

• Mikaelsen, Helena Zaitzow; Ulla, Ingeborg Hjalland; Karimi, David; Mathiesen, Liv; Viktil, Kirsten Kilvik & Syversen, Malin Olsen [Show all 14 contributors for this article] (2024). Medication Discrepancies in Hospitalised Medical Patients – Status After a Decade With Targeted Medication Reconciliation Measures, a Cross-sectional Multicenter Study. Health Services Insights (HSI Journal). 17, p. 1–8. doi: 10.1177/11786329241254202. Full text in Research Archive Show summary

  Several targeted medication reconciliation (MR) initiatives have been introduced to reduce the number of medication discrepancies (MDs). The real-life quality of medication lists at hospital admission has however not been comprehensively investigated in the last decade. We aimed to examine the frequency and potential clinical relevance of MDs at hospital admission and investigate whether certain characteristics are associated with MDs. Patients ⩾18 years old admitted to medical wards at 4 hospitals in Norway were included. MR was performed, and discrepancies between the reconciled medication list and the medication chart were identified. The potential clinical relevance was assessed in a short-term and long-term perspective. We included 250 patients and 201 (80%) had 1 or more MDs, mean 3.2 (SD 2.9) per patient. Out of 824 identified MDs, 171 (20.8%) and 362 (43.9%) were of moderate, major, or extreme potential clinical relevance in short- and long-term perspective, respectively. The risk of MDs increased with increasing age, increasing number of medications, and the use of multidose drug dispensing. Although several targeted MR initiatives have been launched, the frequency of MDs upon hospital admission is still high. However, the potential clinical relevance of the MDs seems less severe, which indicates an improvement.

• Syversen, Malin Olsen; Shah, Sarah Farhin; Mathiesen, Liv; Mowe, Morten & Lea, Marianne (2023). Effect of integrated medicines management on the quality of drug treatment in hospitalised multimorbid patients - a secondary endpoint analysis of a randomised controlled trial. International Journal of Pharmacy Practice (IJPP). ISSN 0961-7671. 31(3), p. 314–320. doi: 10.1093/ijpp/riad007. Full text in Research Archive Show summary

  Abstract Objectives To investigate the effect of integrated medicines management provided to hospitalised multimorbid patients on the quality of drug treatment at discharge measured as the mean number of potential prescribing omissions and potentially inappropriate medicines. Methods Multimorbid patients ≥18 years, using a minimum of four regular drugs from a minimum of two therapeutic drug classes, were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomised controlled trial; the difference between the intervention and control group at discharge in the mean number of potential prescribing omissions and potentially inappropriate medicines, measured with START-2 and STOPP-2 criteria, respectively. The difference between the groups was calculated using rank analysis. Key findings In total, 386 patients were analysed. Integrated medicines management reduced the mean number of potential prescribing omissions at discharge, compared to the control group, 1.34 versus 1.57, respectively (mean difference 0.23, 95% CI 0.07–0.38, P = 0.005, adjusted for values at admission). There was no difference in the mean number of potentially inappropriate medicines at discharge (1.84 versus 1.88, respectively; mean difference 0.03, 95% CI −0.18 to 0.25, P = 0.762, adjusted for values at admission). Conclusions Integrated medicines management delivered to multimorbid patients during a hospital stay led to an improvement in undertreatment. No effect on deprescribing of inappropriate treatment was seen.

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• Glatkauskas, Mikas; Syversen, Malin Olsen; Scott, Michael; Svensberg, Karin; Denstad, Berit Gallefoss & Wibe, Torunn [Show all 7 contributors for this article] (2024). Application of a Human Factors and Systems Engineering Approach to Explore the Hospital to Home transition for patients with multiple long-term conditions. Full text in Research Archive
• Syversen, Malin Olsen; Glatkauskas, Mikas; Benny, Steffi; Horgen, Kristine; Sedeniussen, Sandra Johanne & Hauge, Monica [Show all 12 contributors for this article] (2024). Medication discrepancies revealed by medication reconciliation after hospital discharge in patients with multiple long-term conditions. Full text in Research Archive
• Glatkauskas, Mikas; Syversen, Malin Olsen; Denstad, Berit Gallefoss; Wibe, Torunn; Svensberg, Karin & Scott, Michael [Show all 8 contributors for this article] (2024). Exploring hospital-to-home transition for patients with MLTC's: Human Factors & System Engineering Approach. Full text in Research Archive
• Syversen, Malin Olsen; Glatkauskas, Mikas; Lea, Marianne; Benny, Steffi; Horgen, Kristine & Svensberg, Karin [Show all 7 contributors for this article] (2023). Medication discrepancies after a hospital stay in patients with multiple long term conditions. Full text in Research Archive
• Syversen, Malin Olsen; Mathiesen, Liv; Lea, Marianne & Svensberg, Karin (2025). Optimising medication use in patients with multiple longterm conditions - During and after a hospital stay. Universitetet i Oslo. Full text in Research Archive Show summary

  Increased life expectancy, a broad range of healthcare services, and the growing availability of treatment options have contributed to a higher prevalence of patients living with multiple long-term conditions (MLTCs). However, healthcare systems and treatment guidelines remain largely structured around single conditions, with limited consideration of coexisting conditions or concurrent medication use. Patients with MLTCs often use numerous medications, experience several care transitions due to their complex care needs and are at higher risk of hospitalisations. Altogether, this creates a significant challenge in delivering safe, optimal, and evidence-based healthcare to this vulnerable population. This thesis was designed in response to this emerging and urgent need. The overall aim of this thesis was to obtain knowledge and understanding of how to optimise medication use in patients with MLTCs during and after a hospital stay. This was done by various approaches and through three studies: • First, the frequency of potential prescribing omissions (PPOs) and potentially inappropriate medications (PIMs) at hospital admission and discharge were investigated to estimate the effect of a pharmacist-led intervention on the quality of drug treatment. • Then, the focus was turned to detect the frequency, categories, underlying reasons and potential clinical relevance of medication discrepancies (MDs) between the medication list in discharge summaries and actual medication use after hospital discharge. • Finally, facilitators and barriers to medication self-management in the transition from hospital to home were explored. The first study, described in Paper I, showed that the pharmacist-led intervention had an effect on the mean number of PPOs, but not on the mean number of PIMs at discharge. PPOs and PIMs were frequent in patients with MLTCs, both at hospital admission and discharge. A minimum of 69% of the patients had either a PPO or PIM at any time point. For both the control and intervention group, the number of PIMs decreased from admission to discharge, while the number of PPOs only decreased in the intervention group. It seems essential that a systematic approach and professionals trained in identifying PPOs and PIMs are Incorporated to optimise medication use in this patient group during a hospital stay. However, the hospital may not be the most suitable setting in reducing PIMs. In the second study, presented in Paper II, almost 90% of the patients had at least one MD between the medication list in the discharge summary and actual medication use after hospital discharge. The most frequent category was that a medication was in use, although it was not listed in the discharge summary. The underlying reason was for a majority of the MDs an apparent lack of or insufficient medication reconciliation during the hospital stay. Most MDs were classified as potential minor clinically relevant, however, there was over a five-fold increase in potential clinically relevant MDs, i.e. extreme, major or moderate, in the long-term perspective compared to the short-term perspective. This highlights that the potential clinical relevance increases over time if MDs are not revealed and corrected. Our results indicates that the majority of MDs could be prevented by sufficient actions to obtain accurate medication information during the hospital stay. This may help optimise medication use during and after a hospital stay. The third study, presented in Paper III, was a qualitative study with patients and next of kin. Facilitators and barriers to medication self-management were numerous and complex. For some, the transition from hospital to home was experienced as a sudden handover of responsibility for managing medications. The patients considered support to medication self-management as important. The results suggest that healthcare professionals should adapt an overall holistic approach tailored to the individual patient’s needs to support patients in medication self-management and thereby optimising medication use after hospital discharge. Increased care coordination and patient empowerment seems like crucial components to improve patients’ medication self-management potential in the transition from hospital to home. Altogether, the findings from these studies illustrate the great potential for improvement in how to optimise medication use in patients with MLTCs during and after a hospital stay. As PPOs, PIMs and MDs are preventable, targeted actions to reduce and avoid them, such as giving healthcare professionals sufficient training to identify these, could be a step towards optimising medication use in these vulnerable patients. Patients with MLTCs have various facilitators and barriers to medication self-management, suggesting that an overall holistic and patient-centred approach is needed to improve medication self-management and hence optimise medication use.

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