Factors influencing medication management during emergency department-to-home transitions: a qualitative study using the theoretical domains framework

Abstract Introduction The transition from Emergency department (ED) to home represents a high-risk period in the continuum of patient care, increasing the risk of medication errors, adverse drug events, and poor adherence. This study explored the perspectives of key stakeholder groups on factors influencing medication management during ED-to-home transition, with the goal of informing the design of a pharmacist-led transitional care intervention in the ED. Methods A qualitative study was conducted with key stakeholders, including physicians, nurses, clinical pharmacists, and patient representatives (patients and Patient and Family Advisory Council (PFAC) members), at a secondary care teaching hospital that manages approximately 161,000 ED visits annually. Data were collected using semi-structured interviews and profession-specific focus groups. Participants were recruited over two months through purposive and snowball sampling. Data were transcribed verbatim and analyzed using a hybrid inductive–deductive approach informed by the Theoretical Domains Framework (TDF). Results Of the 27 individuals invited, 23 participated (response rate 85%): 19 healthcare professionals and 4 patient representatives. Challenges to medication management stemmed from a combination of system-level factors (e.g., workflow demands, resource and structural gaps, and poorly integrated care transition and communication pathways), healthcare provider-level factors (skills and expertise, role ambiguity, and competing priorities), and patient-level factors (e.g., communication and engagement barriers, and medication adherence challenges). These barriers were predominantly mapped to the TDF domains of Environmental Context and Resources, Social/Professional Role and Identity, Knowledge, Skills, and Social Influences, and collectively hindered key transitional care activities, including medication reconciliation, patient education, and post-discharge care coordination. Conclusion Suboptimal medication management at ED discharge is driven by multifactorial challenges across the health system, healthcare provider, and patient levels. These findings highlight that multifaceted interventions that optimize the discharge process, enhance care coordination and communication, foster interprofessional collaboration, and support patients in navigating post-ED care may offer potential solutions to improve care transition.