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Klein AA, Petermann J, Brosse F, Piller S, Kramer M, Hanf M, Dinh TS, Schulz-Rothe S, Engler J, Mergenthal K, Seidling HM, Klasing S, Timmesfeld N, van den Akker M, Voigt K. Implementation and evaluation of a complex intervention to improve information availability at the interface between inpatient and outpatient care in older patients with multimorbidity and polypharmacy (HYPERION-TransCare) - study protocol for a pilot and feasibility cluster-randomized controlled trial in general practice in Germany. Pilot Feasibility Stud 2023; 9:146. [PMID: 37608345 PMCID: PMC10463488 DOI: 10.1186/s40814-023-01375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Despite attempts to improve the cross-sectoral flow of information, difficulties remain in routine healthcare. The resulting negative impact on continuity of care is often associated with poor health outcomes, especially in older patients. Our intervention aims to increase information availability with respect to medications and health conditions at the interface between inpatient and outpatient care and to contribute towards improving the quality of care in older patients. This pilot study focuses on feasibility and implementability. METHODS The idea of the complex intervention has been developed in a previous study. This intervention will be tested in a prospective, multicenter, cluster-randomized (via web tool), controlled pilot trial with two parallel study arms (intervention and control group). The pilot study will be conducted in 20 general practices in Hesse and Saxony (Germany) and include 200 patients (≥ 65 years of age with multimorbidity and polypharmacy) recruited by the practices. Practice staff and patients will be blinded. We will use qualitative and quantitative methods to assess the feasibility and implementability of the intervention and the study design in a process evaluation covering topics ranging from expectations to experiences. In addition, the feasibility of proposed outcome parameters for the future definitive trial will be explored. The composite endpoint will include health-related patient outcomes (hospitalization, falls, and mortality using, e.g., the FIMA questionnaire), and we will assess information on medications (SIMS questionnaire), symptoms and side effects of the medication (pro-CTCAE questionnaire), and health literacy (HLQ questionnaire). Data will be collected at study begin (baseline) and after 6 months. Furthermore, the study will include surveys and interviews with patients, general practitioners, and healthcare assistants. DISCUSSION The intervention was developed using a participatory approach involving stakeholders and patients. It aims to empower general practice teams as they provide patient-centered care and play a key role in the coordination and continuity of care. We aim to encourage patients to adopt an active role in their health care. Overall, we want to increase the availability of health-related information for patients and healthcare providers. The results of the pilot study will be used in the design and implementation of the future definitive trial. TRIAL REGISTRATION The study was registered in DRKS-German Clinical Trials Register: registration number DRKS00027649 (date: 19 January 2022). Date and version identifier 10.07.2023; Version 1.3.
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Affiliation(s)
- Astrid-Alexandra Klein
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Steve Piller
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Martin Kramer
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
| | - Maria Hanf
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Hanna M. Seidling
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Sophia Klasing
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Universitätsstraße 105, 44789 Bochum, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany
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Brueckle MS, Dinh TS, Klein AA, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Gonzalez-Gonzalez AI, Kramer M, Engler J, Mergenthal K, Muth C, Voigt K, van den Akker M. Development of an intervention to improve informational continuity of care in older patients with polypharmacy at the interface between general practice and hospital care: protocol for a participatory qualitative study in Germany. BMJ Open 2022; 12:e058016. [PMID: 35387829 PMCID: PMC8987787 DOI: 10.1136/bmjopen-2021-058016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Older patients with multimorbidity, polypharmacy and related complex care needs represent a growing proportion of the population and a challenge for healthcare systems. Particularly in transitional care (hospital admission and hospital discharge), medical errors, inappropriate treatment, patient concerns and lack of confidence in healthcare are major problems that may arise from a lack of information continuity. The aim of this study is to develop an intervention to improve informational continuity of care at the interface between general practice and hospital care. METHODS AND ANALYSIS A qualitative approach will be used to develop our participatory intervention. Overall, 32 semistructured interviews with relevant stakeholders will be conducted and analysed. The stakeholders will include healthcare professionals from the outpatient setting (general practitioners, healthcare assistants, ambulatory care nurses) and the inpatient setting (clinical doctors, nurses, pharmacists, clinical information scientists) as well as patients and informal caregivers. At a series of workshops based on the results of the stakeholder analyses, we aim to develop a participatory intervention that will then be implemented in a subsequent pilot study. The same stakeholder groups will be invited for participation in the workshops. ETHICS AND DISSEMINATION Ethical approval for this study was waived by the Ethics Committee of Goethe University Frankfurt because of the nature of the proposed study. Written informed consent will be obtained from all study participants prior to participation. Results will be tested in a pilot study and disseminated at (inter)national conferences and via publication in peer-reviewed journals. TRIAL REGISTATION NUMBER Clinical Trials Register: registration number DRKS00027649.
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Affiliation(s)
- Maria-Sophie Brueckle
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | | | - Lisa Rietschel
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | | | - Martin Kramer
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Christiane Muth
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Karen Voigt
- Department of General Practice, Dresden University of Technology, Dresden, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
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Goebell PJ. [Sectoral interface-an opportunity for health services research?]. Urologe A 2020; 59:912-918. [PMID: 32638067 DOI: 10.1007/s00120-020-01260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The request for increased outpatient care is currently widely discussed in healthcare debates. With that, the sectoral interface (outpatient/hospital) is receiving greater attention, which provides an incentive for better cooperation and coordination of all healthcare providers. This also marks an opportunity to establish new cross-sectoral structures-also for research. The definitions of cross-sectoral care and the research content need to be in a standardized and consolidated manner. The provision of treatment data along the entire patent's path remains essential for health services research. In this context, the cross-sectoral interface could be regarded as fragile in that it is particularly sensitive to disruptions. The current increasing digitalization can also be seen as an opportunity to minimize the loss of information through the further development of cross-sectoral structures and to improve patient care, while simultaneously making a contribution to research across sectoral borders.
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Affiliation(s)
- P J Goebell
- Urologische und Kinderurologische Universitätsklinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
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Laidig F, May M, Brinkmann J, Schneider N, Stichtenoth DO. Evaluation of potential prescribing errors in patients with polypharmacy: a method to improve medication safety in ambulatory care. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0507-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Greißing C, Buchal P, Kabitz HJ, Schuchmann M, Zantl N, Schiek S, Bertsche T. Medication and Treatment Adherence Following Hospital Discharge. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:749-756. [PMID: 27890051 DOI: 10.3238/arztebl.2016.0749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 04/14/2016] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients' drug regimens often need to be changed when they pass from one care sector to another, but these changes sometimes pose a safety risk. To avoid such risks, a new inter-sector transition concept was developed incorporating discharge medication plans and counseling modules for the patients themselves and the doctors receiving them into their care. METHODS A prospective interventional trial was carried out in two internal medicine wards of a general hospital. After data acquisition from the control group, the transition concept was developed and evaluated in an independent intervention group. The discharge medication plan and the first post-discharge prescription were compared to identify patients who had at least one medication change that increased the post-discharge risk of either failure to achieve the therapeutic goal (category A, first endpoint) or of patient's lack of treatment adherence (category B). Gaps in care after discharge were also analyzed. RESULTS 200 consecutive patients were enrolled in the trial. In the intention-to-treat analysis, the percentage of patients with potentially jeopardizing medication changes in category A declined from 54% (54/100) in the control group to 15% (15/100) in the intervention group. (p<0.001). For medication changes in category B, there was a corresponding decline from 53% (53/100) to 7% (7/100) (p < 0.001). Gaps in care were seen in 28% (28/100) of control patients and 18% (18/100) of patients in the intervention group (p = 0.031). CONCLUSION The likelihood of a potentially jeopardizing medication change upon hospital discharge can be markedly reduced with the aid of a modular transition concept. Gaps in care can be closed in this way as well.
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Affiliation(s)
- Claudia Greißing
- Pharmacy Department, Konstanz Hospital; Drug Safety Center, Leipzig University and University Hospital of Leipzig, Department of Clinical Pharmacy, Institute of Pharmacy, Leipzig University; Konstanz Hospital, Medical Clinic II; Konstanz Hospital, Medical Clinic I; Singen Hospital, Department of Urology and Pediatric Urology
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Greißing C, Kössler K, Freyer J, Hüter L, Buchal P, Schiek S, Bertsche T. The status of the performance of medication reviews in German community pharmacies and assessment of the practical performance. Int J Clin Pharm 2016; 38:1425-1435. [DOI: 10.1007/s11096-016-0381-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
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Mahler C, Freund T, Baldauf A, Jank S, Ludt S, Peters-Klimm F, Haefeli WE, Szecsenyi J. [Structured medication management in primary care - a tool to promote medication safety]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 108:258-69. [PMID: 25066344 DOI: 10.1016/j.zefq.2013.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 07/15/2013] [Accepted: 07/29/2013] [Indexed: 11/17/2022]
Abstract
Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient.
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Affiliation(s)
- Cornelia Mahler
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung.
| | - Tobias Freund
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung
| | - Annika Baldauf
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung
| | - Susanne Jank
- Universitätsklinikum Heidelberg, Medizinische Klinik, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie
| | - Sabine Ludt
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung
| | - Frank Peters-Klimm
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung
| | - Walter Emil Haefeli
- Universitätsklinikum Heidelberg, Medizinische Klinik, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie
| | - Joachim Szecsenyi
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung
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Mehrmann L, Ollenschläger G. [Problem areas and examples of best practice in intersectoral medication treatment--a literature review]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 108:66-77. [PMID: 24602535 DOI: 10.1016/j.zefq.2013.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/23/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
Abstract
Transitions between the outpatient and inpatient sector are a critical phase in medication treatment. This article provides an overview of published problem areas and examples of best practice in the intersectoral medication treatment. Data with regard to related problem areas and examples of best practice was collected in August 2011 by a systematic literature research. The relevant literature was identified using the following databases and search engines: MEDLINE, The Cochrane Library, EMBASE, Google, and Google Scholar. Additionally, a hand search was done on the websites of SpringerLink and Thieme Connect. The initial search yielded a total of 4,409 records which were further selected in two screening steps and analysed according to their relevance. Of the remaining 63 records, 3 exclusively described problem areas, 11 of them examples of best practice, and 49 provided information on both problem areas and examples of best practice with regard to intersectoral medication treatment. Among other things, problem areas include varying legal regulations in inpatient and outpatient medication treatment, drug therapy interruptions after hospital discharge, or deficits in communication and continuity of care. Examples of best practice are projects, programmes, initiatives, recommendations, and points to consider with respect to medication reconciliation, pharmaceutical support, or transitions of care. Problem areas as well as examples of best practice are mainly focused on the transition from inpatient to outpatient care.
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Affiliation(s)
- Lena Mehrmann
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin.
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