Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study

Research output: Contribution to journalResearch articleContributedpeer-review


  • Truc Sophia Dinh - , Goethe University Frankfurt a.M. (Author)
  • Maria Hanf - , Goethe University Frankfurt a.M. (Author)
  • Astrid-Alexandra Klein - , Department of internal Medicine III - Division General Medicine (Author)
  • Maria-Sophie Brueckle - , Goethe University Frankfurt a.M. (Author)
  • Lisa Rietschel - , Medizinische Klinik und Poliklinik III, Bereich Allgemeinmedizin (Author)
  • Jenny Petermann - , Department of internal Medicine III - Division General Medicine (Author)
  • Franziska Brosse - , Medizinische Klinik und Poliklinik III, Bereich Allgemeinmedizin (Author)
  • Sylvia Schulz-Rothe - , Goethe University Frankfurt a.M. (Author)
  • Sophia Klasing - , Heidelberg University  (Author)
  • Christiane Muth - , Bielefeld University (Author)
  • Hanna Seidling - , Heidelberg University  (Author)
  • Jennifer Engler - , Goethe University Frankfurt a.M. (Author)
  • Karola Mergenthal - , Goethe University Frankfurt a.M. (Author)
  • Karen Voigt - , Department of internal Medicine III - Division General Medicine (Author)
  • Marjan van den Akker - , KU Leuven (Author)


BACKGROUND: The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care.

METHODS AND FINDINGS: Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders' tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients' medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management.

CONCLUSIONS: The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding.


Original languageEnglish
Article numbere0300047
JournalPloS one
Issue number4
Publication statusPublished - 4 Apr 2024

External IDs

PubMedCentral PMC10996284
Scopus 85189364552



  • Attitude of Health Personnel, Health Personnel, Humans, Medication Therapy Management, Hospitalization, Qualitative Research, Communication