Development and evaluation of pharmacist-provided teach-back medication counselling at hospital discharge

BACKGROUND

Pharmacists can use teach-back to improve patients' understanding of medication; however, the evidence of its impact on patient outcomes is inconsistent. From the literature, there is no standardised way to provide pharmacist-delivered medication counselling at hospital discharge, with limited reporting on training.

AIM

To develop a standardised medication counselling procedure using teach-back at hospital discharge, and to evaluate feedback from patients and pharmacists on this initiative.

METHOD

A standardised intervention procedure was developed. Participating pharmacists (n = 9) were trained on teach-back via an online education module and watching a demonstration video created by the researchers. Pharmacists provided patients with discharge medication counselling utilising teach-back and a patient-friendly list of medication changes to take home. To obtain feedback, patients were surveyed within seven days of discharge via telephone and pharmacists answered an anonymous survey online.

RESULTS

Thirty-two patients (mean age: 57 years; range: 19-91) were counselled on a mean 2.94 medications/patient with the mean counselling time as 23.6 min/patient. All patients responded to the survey, whereby 93.7% had increased confidence regarding medication knowledge and were satisfied with the counselling and the information provided. All pharmacist survey respondents (n = 8) agreed they were given adequate training and that teach-back was feasible to apply in practice.

CONCLUSION

This is the first study to evaluate patients' views on pharmacist-provided teach-back medication counselling. With positive patient outcomes, a standardised procedure, and a comprehensive description of the training, this study can inform the development of discharge medication counselling utilising teach-back going forward.

Public Perceptions About Home Delivery of Medication Service and Factors Associated with the Utilization of This Service

INTRODUCTION

Home medication delivery service is a major service for the public. It reduces overcrowding and unnecessary visits to health centers. This study aims to investigate the public perception of home delivery of medication service in Jordan and evaluate factors affecting the use of this service.

METHODS

The study was conducted in March 2022 using an online survey. Participants were asked to fill out a validated questionnaire to evaluate their perception of home delivery of medication service.

RESULTS

Among the 1032 adult participated in this study, the majority reported that they had heard of home delivery of medication service (n = 832, 80.6%). However, only 30.9% of them have used this service before. Results showed that 71.4% of the participants (n = 737) believe that home delivery of medication service is more convenient and accessible than in-store drug refill. In addition, 65.6% of the participants (n = 677) believed that home delivery of medication service is suitable only for refill-prescription drugs (65.0%). The main pros of the service as perceived by the study participants were to serve sick patients, elderly, and disabled people (n = 822, 79.7%). In contrast, the inability of patients to build a professional relationship with pharmacists using home delivery of medications service was the most perceived con of this service (n = 627, 60.8%). Finally, regression analysis revealed that older participants, those with chronic diseases, and those who visit community pharmacies two times or more per month revealed higher use of the service (P = <0.05).

CONCLUSION

This study has shown that most participants showed positive perceptions toward the home delivery of medication services. However, participants believed that this service may decrease pharmacist's patient contact time, thus affecting the quality of medication counseling. More comprehensive future studies are necessary to examine the financial aspects of such a service and its associated drawbacks.

Pharmacist-Facilitated Interactive E-Learning for Patients Newly Initiated on Warfarin: A Randomised Controlled Study

It is not known whether electronic-learning (e-learning) is effective for educating hospital inpatients about complex medications such as warfarin. This prospective randomised controlled study compared pharmacist-facilitated e-learning with standard pharmacist-delivered face-to-face education on patients’ or their unpaid carers’ knowledge of warfarin and satisfaction with warfarin education as well as the time that was spent by pharmacists in delivering warfarin education. Adult English-speaking patients (or their carers) who had been prescribed warfarin were randomised to receive standard pharmacist face-to-face education (control) or an e-learning module on a tablet device facilitated by a pharmacist (intervention). All of the participants received written warfarin information and were presented with the opportunity to ask any questions that they may have had to a pharmacist. Fifty-four participants completed the study (27 per group). The participants who received e-learning had median correct Oral Anticoagulation Knowledge (OAK) test scores of 85% compared to 80% for standard education (p = 0.14). The participants in both groups were satisfied with the information that they received. There was a trend towards pharmacists spending less time on warfarin education for the e-learning group than in the standard education group (25.5 vs. 33 min, respectively, p = 0.05). Education delivered via pharmacist-facilitated e-learning was non-inferior in terms of patient or carer warfarin knowledge compared to standard pharmacist-delivered education.

Interventions to Improve Communication at Hospital Discharge and Rates of Readmission: A Systematic Review and Meta-analysis

IMPORTANCE

Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving communication at discharge through specific interventions has an association with patient-relevant outcomes remains unclear.

OBJECTIVE

To conduct a systematic review and meta-analysis on the association of communication interventions at hospital discharge with readmission rates and other patient-relevant outcomes.

DATA SOURCES

PubMed, EMBASE, PsycINFO, and CINAHL were systematically searched from the inception of each database to February 28, 2021.

STUDY SELECTION

Randomized clinical trials that randomized patients to receiving a discharge communication intervention or a control group were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data on outcomes and trial and patient characteristics. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Data were pooled using a random-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

MAIN OUTCOMES AND MEASURES

The primary outcome was hospital readmission, and secondary outcomes included adherence to treatment regimen, patient satisfaction, mortality, and emergency department reattendance 30 days after hospital discharge.

RESULTS

We included 60 randomized clinical trials with a total of 16 070 patients for the qualitative synthesis and 19 trials with a total of 3953 patients for the quantitative synthesis of the primary outcome. Of these, 11 trials had low risk of bias, 6 trials had high risk of bias, and 2 trials had unclear risk of bias. Communication interventions at discharge were significantly associated with lower readmission rates (179 of 1959 patients [9.1%] in intervention groups vs 270 of 1994 patients [13.5%] in control groups; RR, 0.69; 95% CI, 0.56-0.84), higher adherence to treatment regimen (1729 of 2009 patients [86.1%] in intervention groups vs 1599 of 2024 patients [79.0%] in control groups; RR, 1.24; 95% CI, 1.13-1.37), and higher patient satisfaction (1187 of 1949 patients [60.9%] in intervention groups vs 991 of 2002 patients [49.5%] in control groups; RR, 1.41; 95% CI, 1.20-1.66).

CONCLUSIONS AND RELEVANCE

These findings suggest that communication interventions at discharge are significantly associated with fewer hospital readmissions, higher treatment adherence, and higher patient satisfaction and thus are important to facilitate the transition of care.

Impact of pharmacists' training on oral anticoagulant counseling: A randomized controlled trial

OBJECTIVE

The study evaluated the impact of oral anticoagulant counseling training on the quality of counseling provided by pharmacists.

METHODS

A prospective RCT was conducted among 33 pharmacists from 23 pharmacies in Ibadan, Nigeria. Six mystery patients (MPs) who were either warfarin-naïve, experienced adverse drug reaction (ADR), or drug interaction (DI) to warfarin were used to assess pharmacists' oral anticoagulant counseling quality at pre- and post-intervention. A 2-week online oral anticoagulant counseling training was given to the intervention group pharmacists. Quality of counseling was categorized as poor (0-20 %), fair (21-50 %), moderate (51-80 %), and optimal (81-100 %).

RESULTS

At pre-intervention, the quality of oral anticoagulant counseling provided to the MPs was poor. Post-intervention, the quality improved among pharmacists in the intervention group, from poor to fair for both warfarin-naïve MP and MP who experienced DI, and from fair to moderate for MP with ADR.

CONCLUSION

Short-term online oral anticoagulant counseling training improved the quality of counseling provided by community pharmacists to mystery patients on warfarin.

PRACTICE IMPLICATION

Online oral anticoagulant counseling training may be employed by pharmacists' professional bodies intermittently to improve oral anticoagulant counseling.

Effectiveness and impact of a structured research approach for health-system pharmacy administration and leadership residents

PURPOSE

Required competency areas, goals, and objectives for both postgraduate year 1 (PGY1) pharmacy residencies and postgraduate year 2 (PGY2) health-system pharmacy administration and leadership (HSPAL) residencies indicate the importance of research in the residency program by specifying it as a required part of the training process. Research is critical in the field of health-system pharmacy administration, which is built upon the principles of evaluation and assessment, ensuring that all activities implemented in an organization are evaluated through data collection and assessment to determine their impact. Additionally, the research structure provides residents the opportunity to share research broadly, and it also provides the platform for other institutions to implement successful ideas of interest to them.

SUMMARY

This article describes the impact of having a structured, publication-focused research program in an HSPAL residency. The research process has provided follow-up projects (n = 7) and grant participation (n = 6). Additionally, the process has yielded a 66% publication rate, with 21 of 32 thesis substitutes published in various journals. The department of pharmacy at the residency site has noticed that the continued refinement, scoping, and robust methodologies of projects have been essential to their impact in the literature and in dissemination of the accumulated body of knowledge.

CONCLUSION

A structured residency research program has provided direction to HSPAL residents and ensured successful scoping and completion of their research. Intentionality in this aspect has provided HSPAL residents with opportunities for publications, grants, and strong research experiences. Overall, the department of pharmacy has been positively impacted through implementation of services that were evaluated through a structured HSPAL pharmacy residency research program.

Analysis of topics and characteristics of user reviews on different online psychological counseling methods

BACKGROUND

Psychological support is available more widely supported by emerging technologies as an addition to face-to-face consultations, more and more people are accessing psychological support using online resources.

OBJECTIVE

This research provides insights into the perception of the key factors that affect the effectiveness of different online psychological counseling methods through the user reviews of four online psychological counseling modes and the tendency to choose the different counseling methods for users with different psychological problems.

METHODS

Using topic modeling analysis, Gooseeker content analysis, and the TextMind Chinese psychological analysis system, we analyzed 163,377 online reviews from 2,375 psychological consultants extracted from a leading online psychological consultation platform in China.

RESULTS

(1) Telephone counseling gains the most preferences among users. Text counseling has strong privacy protection. Video and face-to-face consultations are more authentic and comprehensive. (2) Parent-child education consultation users are more likely to choose face-to-face consultation, patients with common mental illnesses are more inclined to choose online counseling methods than offline consultation, career planning consultation clients prefer video consultation, and text counseling is more consistent with the periodical characteristics of relationship counseling.

CONCLUSION

The research examined user reviews and used content analysis to understand patients' views on the effectiveness of online counseling methods, which supplement the current research gap through innovation in research methods.

Effectiveness of multimedia interventions in the provision of patient education on anticoagulation therapy: A review

OBJECTIVE

A literature review was conducted to identify available evidence on the use of multimedia patient educational interventions on anticoagulation therapy.

METHODS

A literature search was conducted on 9/4/2020 via six research databases. Publications that evaluated the effects of these interventions on anticoagulation therapy were included.

RESULTS

The review included ten original research studies (five randomized controlled trials, four observational studies and a pre- and post-interventional study), a systematic review and meta-analysis, three systematic reviews, a scoping review, and a literature review. Multimedia interventions significantly improved knowledge after education, but no significant differences found when compared to traditional methods. There was insufficient evidence to conclude whether knowledge retained over time. Patients were equally satisfied with both methods. Multimedia interventions significantly reduced healthcare professional's time required for education. Heterogeneity in intervention, methodology and results limited comparison and combination of findings across studies.

CONCLUSION

Multimedia patient educational interventions on anticoagulation therapy have similar outcomes to traditional methods in knowledge improvement and satisfaction, but they save health personnel time.

PRACTICE IMPLICATIONS

There is lack of evidence to support the effectiveness of multimedia interventions in educating patients on anticoagulation therapy. Larger randomized studies evaluating their benefits in health outcomes and clinical practice are warranted.

The Impact of a Pharmacist-led Warfarin Educational Video in a Saudi Setting

Context:

Internationally, various warfarin education strategies have been described in the medical literature and delivered by a variety of health-care providers. However, none of these were tested in a Saudi setting.

Aim:

The aim of this study was to assess the impact of pharmacist interventions via an educational video on improving patient knowledge of and satisfaction with warfarin therapy and the international normalized ratio (INR).

Setting and Design:

This study adopted a prospective pre- and posttest design and enrolled 91 patients from an anticoagulant clinic at King Khaled University Hospital in Riyadh, Saudi Arabia, between September 2017 and February 2018.

Materials and Methods:

All patients completed the Anticoagulation Knowledge Assessment (AKA) and Anti-Clot Treatment Satisfaction (ACTS) scales. Subsequently, the patients watched a 10-min educational video containing basic information regarding warfarin and were given relevant informative booklets. The patients were reassessed after a mean follow-up period of approximately 52 days.

Results:

In total, 85 patients completed the study. The impact of the intervention on patient knowledge was highly significant (mean difference = 17.7%, 95% confidence interval (CI) = 21.75–13.58, P < 0.000). In addition, the patients showed significant increases in their ACTS benefits subscale scores (mean difference = 0.73, 95% CI = 1.22–0.24, P = 0.004). Despite being long-term warfarin users, the patients’ INRs had a greater tendency to be within the target range after the intervention (56.63% ± 35% vs. 64.72% ± 35% of the time; mean difference, 8.1 percentage points; effect size = 0.23). However, there was no significant effect on patients’ perceptions of the warfarin burden.

Conclusion:

This study provided evidence that a pharmacist-led audiovisual intervention via an educational video coupled with an informational booklet effectively improved patients’ knowledge retention and satisfaction with warfarin therapy benefits. Longer studies are needed to determine the impact of this intervention on patients’ perceptions of warfarin burdens and their INRs.

Warfarin therapy in atrial fibrillation: assessment of patient knowledge of risks and benefits

Patients with atrial fibrillation are at an increased risk for stroke, and many benefits from anticoagulation. Despite the emergence of direct oral anticoagulants, many patients continue to rely on warfarin for their anticoagulation due to logistical, pharmacokinetic, clinical, or patient preference issues. Previous work has suggested that outcomes of warfarin therapy are related to patient education/knowledge. We assessed knowledge of indications, benefits, and complications of warfarin therapy in 99 randomly selected patients enrolled in the Warfarin Anticoagulation Clinic at the Mayo Clinic in Florida who were taking warfarin for non-valvular atrial fibrillation. Patients were labeled as 'knowledgeable' or 'not knowledgeable' regarding warfarin therapy according to the results of a cross-sectional questionnaire. The majority of patients in both the knowledgeable and not knowledgeable groups displayed understanding that they were taking warfarin for atrial fibrillation (valvular vs non-valvular atrial fibrillation was not an included answer choice). However, there was a clear lack of knowledge amongst patients with atrial fibrillation in both groups about their stroke risk while on and off warfarin, and their risk of major bleeding or adverse events related to their warfarin therapy. There was only a significant difference between the two groups regarding their knowledge of what increases or decreases the risk of bleeding while on warfarin. There was no major difference between the groups with regards to demographic and medical characteristics, except that 'not knowledgeable' patients tended to have more peripheral vascular disease, ulcer disease, and moderate-severe renal disease compared to 'knowledgeable' patients.

Effects of iPad Video Education on Patient Knowledge, Satisfaction, and Cardiac Rehabilitation Attendance

PURPOSE

The purpose of this project was to examine the outcomes of using video education as an adjunct to standard discharge education for patients receiving percutaneous coronary intervention. Outcomes included knowledge about heart disease and discharge instructions, satisfaction with the video education, and the percentage of patients with cardiac rehabilitation referrals who attended their first cardiac rehabilitation session.

METHODS

This project analyzed data on 224 participants. A video delivered via an iPad was used to provide adjunct discharge education to patients who underwent percutaneous coronary intervention procedures and were on the 24-hour overnight postrecovery unit. Participants completed a test to gauge knowledge learned. Descriptive statistics, the paired t test, and the Fisher exact test were used to evaluate the efficacy of this education.

RESULTS

A paired t test showed significant knowledge improvement between the pretest percentage correct (mean = 88.97) and the posttest (mean = 96.62): t = -9.657, df = 223, P < .001. A majority of the patients (86.3%, n = 183) were very satisfied with the video education, and 98.1% (n = 208) stated it improved their knowledge and confidence about caring for their heart disease. Despite these reported improvements, there was no significant increase in cardiac rehabilitation attendance (P = .80).

CONCLUSION

Patients of all ages embraced the use of video education on iPads as an adjunct to standard discharge education. Patients felt more confident and informed on discharge about the expectations of caring for their heart disease and the need for cardiac rehabilitation. Despite knowing the benefits of cardiac rehabilitation, it remained an underutilized resource for these patients.

Using technology to enhance medication regimen education after solid organ transplantation

PURPOSE

The design and implementation of a tool that combines clinical teaching with cutting-edge, simplified technology for providing medication education to solid organ transplant (SOT) recipients are described.

METHODS

In a retrospective study of adults who received kidney transplants from February 2015 through May 2017, patients were educated about their medications using a tablet computer application, Medication Regimen Education (MRxEd), that presented concise videos describing the name, indication, dose, adverse effects, and associated interactions of all medications received, as well as special considerations applicable to each agent. Assessment questions were used to reinforce key concepts and identify knowledge gaps.

RESULTS

The digital educational intervention was provided to 282 kidney transplant recipients. Patients were predominantly white (48%) and/or male (63%), with a median age of 51 years (interquartile range, 37-61 years). Patients came from a variety of education backgrounds. Most patients (81%) were educated on dual maintenance immunosuppression (with tacrolimus and mycophenolate) and 3 infection prophylaxis agents (nystatin, sulfamethoxazole-trimethoprim, and valganciclovir). Most patients (90%) correctly answered questions related to medication indications, dosing, and special rules, but many (61%) had difficulty correctly answering questions about adverse effects.

CONCLUSION

An innovative approach for interactive and engaging medication teaching with the MRxEd application enhanced the education process for SOT recipients.

Patient-focused interventions to support vulnerable people using oral anticoagulants: a narrative review

The aim of this review was to identify patient-focused interventions that have been trialed to support vulnerable patient populations taking oral anticoagulants (warfarin and the direct-acting oral anticoagulants (DOACs)) such as older persons (65 years and over), those with limited health literacy, and those from culturally and linguistically diverse (CALD) backgrounds. This review also aimed to report on the effects of these interventions on outcomes relevant to the use of anticoagulant therapy. Original articles published between 1 January 1995 and 30 June 2017 were identified using several electronic databases such as Medline, Ovid, Embase, Scopus, Cochrane, and Google Scholar. The following terms were used for the three-tiered search: Tier 1, elderly, aged, older adult, geriatrics; Tier 2, health literacy, literacy, low health literacy, low English proficiency, patient literacy; and Tier 3, ethnicity, ethnic, ethnic groups, CALD, culturally and linguistically diverse, NESB, non-English speaking background, race, racial groups, religion, religious groups, and minority groups. The terms for each tier were combined with the following terms: anticoagulants, anticoagulation, warfarin, apixaban, dabigatran, rivaroxaban, DOACS, new oral anticoagulants, novel oral anticoagulants, patient care, patient knowledge, comprehension, patient education, patient participation, and communication. A total of 41 studies were identified. Most of the interventions identified included older persons taking warfarin who were monitored using the international normalized ratio (INR) and who received patient education. Many interventions reported a significant positive impact on patients' knowledge, reduction in the number of adverse events caused by hemorrhage, and better INR control. More research on patient-focused interventions is needed that includes patients with limited health literacy, those from CALD backgrounds, and family members and caregivers of patients taking oral anticoagulants.

Implementation of patient education software in an anticoagulation clinic to decrease visit times for new patient appointments

OBJECTIVE

Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.

METHODS

Patients viewed the video in the waiting area with a goal to decrease visit times by 15 min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.

RESULTS

Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4 min, p = 0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.

CONCLUSION

Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.

PRACTICE IMPLICATIONS

Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction.

Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation

BACKGROUND

Current guidelines recommend oral anticoagulation therapy for patients with atrial fibrillation (AF) with one or more risk factors for stroke; however, anticoagulation control (time in therapeutic range (TTR)) with vitamin K antagonists (VKAs) is dependent on many factors. Educational and behavioural interventions may impact patients' ability to maintain their international normalised ratio (INR) control. This is an updated version of the original review first published in 2013.

OBJECTIVES

To evaluate the effects of educational and behavioural interventions for oral anticoagulation therapy (OAT) on TTR in patients with AF.

SEARCH METHODS

We updated searches from the previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library (January 2016, Issue 1), MEDLINE Ovid (1949 to February week 1 2016), EMBASE Classic + EMBASE Ovid (1980 to Week 7 2016), PsycINFO Ovid (1806 to Week 1 February 2016) and CINAHL Plus with Full Text EBSCO (1937 to 16/02/2016). We applied no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials evaluating the effect of any educational and behavioural intervention compared with usual care, no intervention, or intervention in combination with other self-management techniques among adults with AF who were eligible for, or currently receiving, OAT.

DATA COLLECTION AND ANALYSIS

Two of the review authors independently selected studies and extracted data. Risk of bias was assessed using the Cochrane 'Risk of bias' tool. We included outcome data on TTR, decision conflict (patient's uncertainty in making health-related decisions), percentage of INRs in the therapeutic range, major bleeding, stroke and thromboembolic events, patient knowledge, patient satisfaction, quality of life (QoL), beliefs about medication, illness perceptions, and anxiety and depression. We pooled data for three outcomes - TTR, anxiety and depression, and decision conflict - and reported mean differences (MD). Where insufficient data were present to conduct a meta-analysis, we reported effect sizes and confidence intervals (CI) from the included studies. We evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

MAIN RESULTS

Eleven trials with a total of 2246 AF patients (ranging from 14 to 712 by study) were included within the review. Studies included education, decision aids, and self-monitoring plus education interventions. The effect of self-monitoring plus education on TTR was uncertain compared with usual care (MD 6.31, 95% CI -5.63 to 18.25, I2 = 0%, 2 trials, 69 participants, very low-quality evidence). We found small but positive effects of education on anxiety (MD -0.62, 95% CI -1.21 to -0.04, I2 = 0%, 2 trials, 587 participants, low-quality evidence) and depression (MD -0.74, 95% CI -1.34 to -0.14, I2 = 0%, 2 trials, 587 participants, low-quality evidence) compared with usual care. The effect of decision aids on decision conflict favoured usual care (MD -0.1, 95% CI -0.17 to -0.02, I2 = 0%, 2 trials, 721 participants, low-quality evidence).

AUTHORS' CONCLUSIONS

This review demonstrates that there is insufficient evidence to draw definitive conclusions regarding the impact of educational or behavioural interventions on TTR in AF patients receiving OAT. Thus, more trials are needed to examine the impact of interventions on anticoagulation control in AF patients and the mechanisms by which they are successful. It is also important to explore the psychological implications for patients suffering from this long-term chronic condition.