GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

Informal strategies of power in the local planning system

Existing studies that question the role of planning as a state institution, whose interests it serves together with those disputing the merits of collaborative planning are all essentially concerned with the broader issue of power in society. Although there have been various attempts to highlight the distorting effects of power, the research emphasis to date has been focused on the operation of power within the formal structures that constitute the planning system. As a result, relatively little attention has been attributed to the informal strategies or tactics that can be utilised by powerful actors to further their own interests. This article seeks to address this gap by identifying the informal strategies used by the holders of power to bypass the formal structures of the planning system and highlight how these procedures are to a large extent systematic and (almost) institutionalised in a shadow planning system. The methodology consists of a series of semi-structured qualitative interviews with 20 urban planners working across four planning authorities within the Greater Dublin Area, Ireland. Empirical findings are offered that highlight the importance of economic power in the emergence of what essentially constitutes a shadow planning system. More broadly, the findings suggest that much more cognisance of the structural relations that govern how power is distributed in society is required and that ‘light touch’ approaches that focus exclusively on participation and deliberation need to be replaced with more radical solutions that look towards the redistribution of economic power between stakeholders.