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Pevnick JM, Keller MS, Kennelty KA, Nuckols TK, Ko EM, Amer K, Anderson L, Armbruster C, Conti N, Fanikos J, Guan J, Knight E, Leang DW, Llamas-Sandoval R, Matta L, Moriarty D, Murry LT, Muske AM, Nguyen AT, Phung E, Rosen O, Rosen SL, Salandanan A, Shane R, Schnipper JL. The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization. Contemp Clin Trials 2021; 106:106419. [PMID: 33932574 DOI: 10.1016/j.cct.2021.106419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals. METHODS/DESIGN The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission. DISCUSSION If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04071951.
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Affiliation(s)
- Joshua M Pevnick
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Korey A Kennelty
- College of Pharmacy, University of Iowa, Iowa City, IA, United States of America; Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Teryl K Nuckols
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - EunJi Michelle Ko
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Kallie Amer
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Laura Anderson
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Christine Armbruster
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Nicole Conti
- Dept of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States of America
| | - John Fanikos
- Dept of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States of America
| | - James Guan
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Emmanuel Knight
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Donna W Leang
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ruby Llamas-Sandoval
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Lina Matta
- Dept of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Dylan Moriarty
- Dept of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Logan T Murry
- College of Pharmacy, University of Iowa, Iowa City, IA, United States of America
| | - Anne Marie Muske
- Dept of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States of America
| | - An T Nguyen
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Emily Phung
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Olga Rosen
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sonja L Rosen
- Section of Geriatric Medicine, Division of Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Audrienne Salandanan
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Rita Shane
- Department of Pharmacy, Cedar-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jeffrey L Schnipper
- Brigham Health Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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The effect of a pharmaceutical transitional care program on rehospitalisations in internal medicine patients: an interrupted-time-series study. BMC Health Serv Res 2019; 19:717. [PMID: 31638992 PMCID: PMC6805673 DOI: 10.1186/s12913-019-4617-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/07/2019] [Indexed: 11/11/2022] Open
Abstract
Background Medication errors at transition of care can adversely affect patient safety. The objective of this study is to determine the effect of a transitional pharmaceutical care program on unplanned rehospitalisations. Methods An interrupted-time-series study was performed, including patients from the Internal Medicine department using at least one prescription drug. The program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within six months post-discharge. Secondary outcomes were drug-related hospital visits, drug-related problems (DRPs), adherence, believes about medication, and patient satisfaction. Interrupted time series analysis was used for the primary outcome and descriptive statistics were performed for the secondary outcomes. Results In total 706 patients were included. At 6 months, the change in trend for unplanned rehospitalisations between usual care and the program group was non-significant (− 0.2, 95% CI -4.9;4.6). There was no significant difference for drug-related visits although visits due to medication reconciliation problems occurred less often (4 usual care versus 1 intervention). Interventions to prevent DRPs were present for all patients in the intervention group (mean: 10 interventions/patient). No effect was seen on adherence and beliefs about medication. Patients were significantly more satisfied with discharge counselling (68.9% usual care vs 87.1% program). Conclusions The transitional pharmaceutical care program showed no effect on unplanned rehospitalisations. This lack of effect is probably because the reason for rehospitalisations are multifactorial while the transitional care program focused on medication. There were less hospital visits due to medication reconciliation problems, but further large scale studies are needed due to the small number of drug-related visits. (Dutch trial register: NTR1519).
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Wuyts J, Vande Ginste M, De Lepeleire J, Foulon V. Discharge report for the community pharmacist: Development and validation of a prototype. Res Social Adm Pharm 2019; 16:168-177. [PMID: 31078447 DOI: 10.1016/j.sapharm.2019.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/10/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The potential benefit of community pharmacist's involvement in continuity of care is well-known. However, it is not standard practice to exchange information with the community pharmacist (CP) after hospitalization. OBJECTIVE To construct and validate an evidence-based prototype of a discharge report for the community pharmacist. METHODS First, a review of literature, guidelines and established initiatives was performed to construct a preliminary discharge report. Secondly, the content of the discharge report was reviewed and optimized using semi-structured individual interviews with CPs and general practitioners (GPs). RESULTS The review identified six guidelines for information exchange with the CP originating from three countries, 17 research papers and three local initiatives. Overall, 49 different elements for a discharge document were identified. Based on recurring elements, a preliminary discharge report was created. Interviews with ten CPs and nine GPs provided insights into which information is considered crucial for patient safety and why. This allowed an optimization of the document. The final discharge report consists of three categories: administrative, medication and medical data. The medication data includes medication registered at hospital admission as well as at hospital discharge, drug indications, reasons for initiating, adjusting or discontinuing therapies and start/stop dates. The medical data contains reasons for hospitalization, comorbidities and allergies. CONCLUSIONS The literature review and semi-structured interviews resulted in an evidence-based prototype of a discharge report for the community pharmacist. This document contains both administrative, medical and medication data.
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Affiliation(s)
- Joke Wuyts
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium.
| | - Marie Vande Ginste
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium.
| | - Jan De Lepeleire
- KU Leuven, Department Public Health and Primary Care, 3000, Leuven, Belgium.
| | - Veerle Foulon
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium.
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Daliri S, Hugtenburg JG, ter Riet G, van den Bemt BJF, Buurman BM, Scholte op Reimer WJM, van Buul-Gast MC, Karapinar-Çarkit F. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-After prospective study. PLoS One 2019; 14:e0213593. [PMID: 30861042 PMCID: PMC6413946 DOI: 10.1371/journal.pone.0213593] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge. METHODS A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data. RESULTS We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79). CONCLUSIONS A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
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Affiliation(s)
- Sara Daliri
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, the Netherlands
- Community Pharmacy Westwijk, Amsterdam, the Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Pharmacy, University Medical Centre Maastricht, the Netherlands
| | - Bianca M. Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma J. M. Scholte op Reimer
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- * E-mail: (SD); (FKÇ)
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Ravn-Nielsen LV, Duckert ML, Lund ML, Henriksen JP, Nielsen ML, Eriksen CS, Buck TC, Pottegård A, Hansen MR, Hallas J. Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission: A Randomized Clinical Trial. JAMA Intern Med 2018; 178:375-382. [PMID: 29379953 PMCID: PMC5885912 DOI: 10.1001/jamainternmed.2017.8274] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society. OBJECTIVE To determine whether a multifaceted pharmacist intervention based on medication review, patient interview, and follow-up can reduce the number of readmissions and emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical multicenter study (Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer [OPTIMIST]) enrolled patients from September 1, 2013, through April 23, 2015, with a follow-up of 6 months completed on October 31, 2015. Consecutive medical patients in an acute admission ward who were 18 years or older and who used 5 or more medications were invited to participate. Of 1873 patients invited to participate, 1499 (80.0%) accepted. The medication review and patient interview were conducted in the hospital and followed up in collaboration with primary care. Analysis was based on intention to treat. INTERVENTIONS The patients were randomized into 3 groups receiving usual care (no intervention), a basic intervention (medication review), and an extended intervention (medication review, 3 motivational interviews, and follow-up with the primary care physician, pharmacy, and nursing home). MAIN OUTCOMES AND MEASURES The prespecified primary outcomes were readmission within 30 or 180 days and ED visits within 180 days. The primary composite end point was readmission or an ED visit within 180 days. Secondary outcomes were drug-related readmissions within 30 and 180 days after inclusion, and all-cause mortality and drug-related mortality. RESULTS A total of 1467 patients (679 men [46.3%] and 788 women [53.7%]; median age, 72 years; interquartile range, 63-80 years) were part of the primary analysis, including 498 randomized to usual care, 493 randomized to the basic intervention, and 476 randomized to the extended intervention. The extended intervention had a significant effect on the numbers of patients who were readmitted within 30 days (hazard ratio [HR], 0.62; 95% CI, 0.46-0.84) or within 180 days (HR, 0.75; 95% CI, 0.62-0.90) after inclusion and on the number of patients who experienced the primary composite end point (HR, 0.77; 95% CI, 0.64-0.93). The study showed a nonsignificant reduction in drug-related readmissions within 30 days (HR, 0.65; 95% CI, 0.39-1.09) and within 180 days (HR, 0.80; 95% CI, 0.59-1.08) after inclusion and in deaths (HR, 0.83; 95% CI, 0.22-3.11). The number needed to treat to achieve the primary composite outcome for the extended intervention (vs usual care) was 12. CONCLUSIONS AND RELEVANCE A multifaceted clinical pharmacist intervention may reduce the number of ED visits and hospital readmissions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03079375.
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Affiliation(s)
| | - Marie-Louise Duckert
- Hospital Pharmacy of Funen, Clinical Pharmacy Department, Odense University Hospital, Odense, Denmark
| | - Mia Lolk Lund
- Hospital Pharmacy of Funen, Clinical Pharmacy Department, Odense University Hospital, Odense, Denmark
| | | | | | | | | | - Anton Pottegård
- Hospital Pharmacy of Funen, Clinical Pharmacy Department, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense
| | - Morten Rix Hansen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Uitvlugt EB, Suijker R, Janssen MJA, Siegert CEH, Karapinar-Çarkit F. Quality of medication related information in discharge letters: A prospective cohort study. Eur J Intern Med 2017; 46:e23-e25. [PMID: 28986157 DOI: 10.1016/j.ejim.2017.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Elien B Uitvlugt
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Regina Suijker
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Marjo J A Janssen
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Carl E H Siegert
- OLVG, Department of Internal Medicine, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Fatma Karapinar-Çarkit
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
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Welner S, Kubin M, Folkerts K, Haas S, Khoury H. Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies. Thromb Haemost 2017; 106:600-8. [DOI: 10.1160/th11-03-0168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 07/06/2011] [Indexed: 12/24/2022]
Abstract
SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.
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Duedahl TH, Hansen WB, Kjeldsen LJ, Graabæk T. Pharmacist-led interventions improve quality of medicine-related healthcare service at hospital discharge. Eur J Hosp Pharm 2017; 25:e40-e45. [PMID: 31157065 DOI: 10.1136/ejhpharm-2016-001166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 04/29/2017] [Accepted: 05/05/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives This study aims to investigate the effects on quality of the medicine-related healthcare service provided at hospital discharge after implementing a pharmacist-led patient-centred discharge service. Methods Medical in-patients ready for discharge and prescribed at least six medicines were eligible for inclusion in this descriptive intervention study. A ward-based clinical pharmacist provided a patient-centred discharge service which comprised medication review (including reconciliation if appropriate), medication counselling and verification of the medication discharge summary plans. Satisfaction with the pharmacist-led interventions was collected by questionnaires and follow-up telephone interviews. A quality audit on the medical information stated in the discharge summary plans was conducted. Results A total of 313 medical records were prospectively reviewed by the clinical pharmacist, and 745 medicine-related problems each leading to a clinical recommendation were identified. The total rate of acceptance by the physicians was found to be 84%. The quality audit revealed a significantly higher quality of the medication discharge summary plans sent to primary care regarding content of updated lists of medication after the pharmacist's intervention. The involved physicians stated that contributions from the pharmacist had eased their workload and helped them to obtain a more rational prescribing practice. The interviewed patients felt secure and well-informed about their medicines. Conclusions Contributions from clinical pharmacists can improve both the quality of and satisfaction with the medicine-related healthcare service provided at hospital discharge and secure continuity of medical care at transitions.
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Affiliation(s)
| | | | | | - Trine Graabæk
- Department of Quality, Hospital of South West Jutland, Esbjerg, Denmark
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9
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Karapinar-Çarkıt F, van der Knaap R, Bouhannouch F, Borgsteede SD, Janssen MJA, Siegert CEH, Egberts TCG, van den Bemt PMLA, van Wier MF, Bosmans JE. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital. PLoS One 2017; 12:e0174513. [PMID: 28445474 PMCID: PMC5406030 DOI: 10.1371/journal.pone.0174513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. Methods A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs) was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping. Results In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51), and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001). Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847). Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained. Conclusion The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events) as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519
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Affiliation(s)
| | | | | | | | | | | | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Marieke F. van Wier
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Eibergen L, Janssen MJA, Blom L, Karapinar-Çarkit F. Informational needs and recall of in-hospital medication changes of recently discharged patients. Res Social Adm Pharm 2017; 14:146-152. [PMID: 28552679 DOI: 10.1016/j.sapharm.2017.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The need for information for patients and caregivers at the point of hospital discharge is paramount and potentially extensive. OBJECTIVE The objective of this study was to assess patients' informational needs at hospital discharge, patients' recall of medication changes implemented in the hospital and patients' medication related problems experienced one week after hospital discharge. METHODS The study was conducted in a teaching hospital where patients received structured discharge counseling. Patients were interviewed at hospital discharge regarding their informational needs. One week post-discharge, patients were interviewed by phone to assess any changes in informational needs, their recall regarding in-hospital medication changes and the medication related problems. Descriptive analysis and logistic regression were used to address study objectives. RESULTS The 124 patients in the study regarded the following topics as most relevant for counseling: what the medicine is for (57%), side effects (52%), drug-drug interactions (45%), action of the drug (37%) and reimbursement (31%). In 9% of patients the informational needs changed post-discharge, e.g. the topic side effects increased in importance. Forty-nine percent could recall whether and which medication was changed during hospitalization. Medication-related problems and side effects were reported by respectively 27% and 15% of patients, whereas only 7% contacted their doctor or pharmacist. CONCLUSIONS Patients' informational needs are very individual and can change post-discharge. Despite structured counseling, only half of the patients were able to recall the medication changes implemented in the hospital. Furthermore, patients reported several problems for which they did not consult a healthcare provider. This insight could help in smoothing the transition from hospital to the primary care setting.
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Affiliation(s)
- Liesbeth Eibergen
- OLVG Hospital, Department of Clinical Pharmacy, Amsterdam, The Netherlands.
| | - Marjo J A Janssen
- OLVG Hospital, Department of Clinical Pharmacy, Amsterdam, The Netherlands.
| | - Lyda Blom
- UPPER, Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute of Sciences, Utrecht University, Utrecht, The Netherlands.
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11
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The effect of the TIM program (Transfer ICU Medication reconciliation) on medication transfer errors in two Dutch intensive care units: design of a prospective 8-month observational study with a before and after period. BMC Health Serv Res 2017; 17:124. [PMID: 28183302 PMCID: PMC5301448 DOI: 10.1186/s12913-017-2065-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/31/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The transfer of patients to and from the Intensive Care Unit (ICU) is prone to medication errors. The aim of the present study is to determine whether the number of medication errors at ICU admission and discharge and the associated potential harm and costs are reduced by using the Transfer ICU and Medication reconciliation (TIM) program. METHODS This prospective 8-month observational study with a pre- and post-design will assess the effects of the TIM program compared with usual care in two Dutch hospitals. Patients will be included if they are using at least one drug before hospital admission and will stay in the ICU for at least 24 h. They are excluded if they are transferred to another hospital, admitted and discharged in the same weekend or unable to communicate in Dutch or English. In the TIM program, a clinical pharmacist reconciles patient's medication history within 24 h after ICU admission, resulting in a "best possible" medication history and presents it to the ICU doctor. At ICU discharge the clinical pharmacist reconciles the prescribed ICU medication and the medication history with the ICU doctor, resulting in an ICU discharge medication list with medication prescription recommendations for the general ward doctor. Primary outcome measures are the proportions of patients with one or more medication transfer errors 24 h after ICU admission and 24 h after ICU discharge. Secondary outcome measures are the proportion of patients with potential adverse drug events, the severity of potential adverse drug events and the associated costs. For the primary outcome relative risks and 95% confidence intervals will be calculated. DISCUSSION Strengths of this study are the tailor-made design of the TIM program and two participating hospitals. This study also has some limitations: A potential selection bias since this program is not performed during the weekends, collecting of potential rather than actual adverse drug events and finally a relatively short study period. Nevertheless, the findings of this study will provide valuable information on a crucial safety intervention in the ICU. TRIAL REGISTRATION Dutch trial register: NTR4159 , 5 September 2013.
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Abstract
The purpose of this study was to examine the number and types of discrepancy errors present after discharge from home healthcare in older adults at risk for medication management problems following an episode of home healthcare. More than half of the 414 participants had at least one medication discrepancy error (53.2%, n = 219) with the participant's omission of a prescribed medication (n = 118, 30.17%) occurring most frequently. The results of this study support the need for home healthcare clinicians to perform frequent assessments of medication regimens to ensure that the older adults are aware of the regimen they are prescribed, and have systems in place to support them in managing their medications.
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Sakaguchi FH, Lenert LA. Improving Continuity of Care via the Discharge Summary. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1111-1120. [PMID: 26958250 PMCID: PMC4765640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Discharge summaries (DCS) frequently fail to improve the continuity of care. A chart review of 188 DCS was performed to identify specific components that could be improved through health information technology. Medication reconciliations were analyzed for completeness and for medical reasoning. Documentation of pending results and follow-up details were analyzed. Patient preferences, patient goals, and the handover tone were noted. Patients were discharged on an average of 9.8 medications, only 3% of medication reconciliations were complete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges though only 14% were mentioned in the DCS. Documentation of clear, timely follow-up was present for less than 50% of patients. Patient preferences, patient goals, and lessons learned were rarely included. A handover tone was in only 17% of the DCS. Evaluating the DCS as a clinical handover is novel but information for safe handovers is frequently missing.
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Uitvlugt EB, Siegert CEH, Janssen MJA, Nijpels G, Karapinar-Çarkit F. Completeness of medication-related information in discharge letters and post-discharge general practitioner overviews. Int J Clin Pharm 2015; 37:1206-12. [PMID: 26337836 DOI: 10.1007/s11096-015-0187-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication and documentation of medication-related information are needed to improve continuity of care. OBJECTIVE To assess the completeness of medication-related information in discharge letters and post-discharge general practitioner (GP)-overviews. SETTING A general teaching hospital in Amsterdam, the Netherlands. METHOD An observational study was performed. Patients from several departments were included after medication reconciliation at hospital discharge. In liaison with the resident and patient, a pharmacy team prepared a Transitional Pharmaceutical Care (TPC)-overview of current medications, including changes and allergies. The resident was instructed to download the TPC-overview into the discharge letter instead of typing a self-made medication list. Medication overviews were gathered from the GP 2 weeks after the handover of the discharge letter. The TPC-overview (gold standard) was compared with the information in the discharge letter and post-discharge GP-overviews regarding correct medications and allergies. Descriptive data analysis was used. MAIN OUTCOME MEASURE The number and percentage of complete medication-related information in the discharge letter and the GP-overview were compared to the TPC-overview. RESULTS Ninety-nine patients were included. Medication-related information was complete in 62 (63 %) of 99 discharge letters. Sixteen of 99 GP-overviews (16 %) were complete. Communication of medication-related information increased documentation by the GP, but the medication history could still be incomplete, mainly regarding medication changes and allergies. CONCLUSIONS Medication-related information is lost in discharge letters and GP-overviews post-discharge despite in-hospital medication reconciliation. This could result in discontinuity of care.
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Affiliation(s)
- Elien B Uitvlugt
- Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - Carl E H Siegert
- Department of Internal Medicine, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Marjo J A Janssen
- Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Giel Nijpels
- Department of General Practice, EMGO Institute VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
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Tallon M, Barragry J, Allen A, Breslin N, Deasy E, Moloney E, Delaney T, Wall C, O'Byrne J, Grimes T. Impact of the Collaborative Pharmaceutical Care at Tallaght Hospital (PACT) model on medication appropriateness of older patients. Eur J Hosp Pharm 2015; 23:16-21. [PMID: 31156809 DOI: 10.1136/ejhpharm-2014-000511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/28/2015] [Accepted: 06/02/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives A high prevalence of potentially inappropriate prescribing (PIP) has been identified in older patients in Ireland. The impact of the Collaborative Pharmaceutical Care at Tallaght Hospital (PACT) model on the medication appropriateness of acute hospitalised older patients during admission and at discharge is reported. Methods Uncontrolled before-after study. The study population for this study was medical patients aged ≥65 years, using ≥3 regular medicines at admission, taken from a previous before-after study. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT model involved clinical pharmacists being physician team-based, leading admission and discharge medication reconciliation and undertaking prescription review, with authority to change the prescription during admission or at discharge. The primary outcome was the Medication Appropriateness Index (MAI) score applied pre-admission, during admission and at discharge. Results Some 108 patients were included (48 PACT, 60 standard). PACT significantly improved the MAI score from pre-admission to admission (mean difference 2.4, 95% CI 1.0 to 3.9, p<0.005), and from pre-admission to discharge (mean difference 4.0, 95 CI 1.7 to 6.4, p<0.005). PACT resulted in significantly fewer drugs with one or more inappropriate rating at discharge (PACT 15.0%, standard 30.5%, p<0.001). The MAI criteria responsible for most inappropriate ratings were 'correct directions' (4.8% PACT, 17.3% standard), expense (5.3% PACT, 5.7% standard) and dosage (0.6% PACT, 4.0% standard). PACT suggestions to optimise medication use were accepted more frequently, and earlier in the hospital episode, than standard care (96.7% PACT, 69.3% standard, p<0.05). Conclusions Collaborative pharmaceutical care between physicians and pharmacists from admission to discharge, with authority for pharmacists to amend the prescription, improves medication appropriateness in older hospitalised Irish patients.
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Affiliation(s)
- Maria Tallon
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - John Barragry
- Medical Directorate, Tallaght Hospital Dublin, Ireland
| | - Ann Allen
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - Niall Breslin
- Medical Directorate, Tallaght Hospital Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - Eddie Moloney
- Medical Directorate, Tallaght Hospital Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | | | - John O'Byrne
- Pharmacy Department, Tallaght Hospital Dublin, Ireland
| | - Tamasine Grimes
- Pharmacy Department, Tallaght Hospital Dublin, Ireland.,School of Pharmacy, Trinity College Dublin, Ireland
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Completeness of patient records in community pharmacies post-discharge after in-patient medication reconciliation: a before-after study. Int J Clin Pharm 2014; 36:807-14. [PMID: 25027255 DOI: 10.1007/s11096-014-9965-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transfer of discharge medication related information to community pharmacies could improve continuity of care. This requires for community pharmacies to accurately update their patient records when new information is transferred. An instruction manual that specifies how to document information regarding medication changes and clinical information (i.e. allergies/contraindications) could support community pharmacies. OBJECTIVE To explore the effect of instruction manuals sent to community pharmacies on completeness of their patient records. SETTING A before-after study was performed (July 2009-August 2010) in the St Lucas Andreas Hospital, a general teaching hospital in Amsterdam, The Netherlands. METHODS Patients discharged from the cardiology and respiratory ward were included consecutively. The intervention consisted of a training session for community pharmacies regarding documentation problems and faxing an instruction manual to community pharmacies specifying how to document discharge information in their information system. Usual care consisted of faxing a discharge medication overview to community pharmacies without additional instructions. Two weeks after discharge the medication records of community pharmacies were collected by fax. These were compared with the initial discharge overviews regarding completeness of medication changes (i.e. explicit explanation that medication had been changed) and clinical information documentation. MAIN OUTCOME MEASURE OUTCOMES: were the number and percentage of completely documented medication changes (either needing to be dispensed or not) and clinical information items. The sample size was calculated at 107 patients per measurement period. Multivariable logistic regression was used for analysis. RESULTS Two hundred and eighteen patients (112 before-106 after) were included. Completeness of medication changes documentation increased marginally after the intervention (46.6 vs 56.3 %, adjusted Odds Ratio 1.4 [95 % confidence interval 1.07-1.83]). Documentation increased when medication was actually dispensed by the community pharmacy. No significant improvements were seen for allergy and contraindication documentation. CONCLUSION The intervention is insufficient to increase the completeness of documentation by community pharmacies as marginal improvements were achieved. Future studies should evaluate whether electronic infrastructures may help in achieving updated medication records to improve continuity of pharmaceutical care.
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Kirkham HS, Clark BL, Paynter J, Lewis GH, Duncan I. The effect of a collaborative pharmacist–hospital care transition program on the likelihood of 30-day readmission. Am J Health Syst Pharm 2014; 71:739-45. [DOI: 10.2146/ajhp130457] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Jacquelyn Paynter
- Rockdale Medical Center, Conyers, GA; at the time of writing she was Executive Director, Care Management, DeKalb Medical, Decatur, GA
| | - Geraint H. Lewis
- Patients and Information, National Health Service England, Leeds, United Kingdom
| | - Ian Duncan
- Clinical Outcomes and Analytics, Walgreen Company
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Simoens S, Dubois C, Spinewine A, Foulon V, Paulus D. Drug substitution associated with a hospital stay in Belgium: a retrospective analysis of a claims database. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 22:105-11. [DOI: 10.1111/ijpp.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/07/2013] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
This study measures the extent of drug substitution associated with a hospital stay in Belgium.
Methods
Data were extracted from the 2006–2007 dataset of the Belgian Agency of Health Insurance Funds on drug use of patients hospitalized in acute hospitals. Reimbursed drugs received in ambulatory care during the 3 months prior to hospitalization were compared with drugs received during the 3 months following hospital discharge. Both a narrow definition and a broad definition were used for drug substitution. Narrow substitution (switches between generic and originator drugs) was computed for 14 drug classes for chronic conditions with the highest public expenditure. Broad substitution (changes between chemical substances within the drug class at ATC level 4, changes in brand name) was calculated for statins and proton-pump inhibitors only.
Key findings
The database included 17 764 patients (mean age 66 ± 17 years; 60% female). In 71% of cases an originator drug was received prior to and following hospitalization. A generic drug was received prior to and following hospitalization in 25% of cases. Some form of narrow substitution occurred in 4% of cases: a generic drug was replaced by an originator drug in 2% of cases and an originator drug was replaced by a generic drug in 2% of cases. Some form of broad substitution occurred in 25% of cases for proton-pump inhibitors and 13% of cases for statins.
Conclusions
Hospitalization was not a trigger for changes between originator and generic versions of a drug. Broad substitution associated with a hospital stay was relatively limited for statins and proton-pump inhibitors.
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Affiliation(s)
- Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Cécile Dubois
- Belgian Healthcare Knowledge Centre, Brussels, Belgium
| | - Anne Spinewine
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- CHU Mont-Godinne, Yvoir, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Coccia M. Path-breaking target therapies for lung cancer and a far-sighted health policy to support clinical and cost effectiveness. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2013.09.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Grimes TC, Deasy E, Allen A, O'Byrne J, Delaney T, Barragry J, Breslin N, Moloney E, Wall C. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Qual Saf 2014; 23:574-83. [PMID: 24505112 PMCID: PMC4078714 DOI: 10.1136/bmjqs-2013-002188] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the benefits of the Collaborative Pharmaceutical Care in Tallaght Hospital (PACT) service versus standard ward-based clinical pharmacy in adult inpatients receiving acute medical care, particularly on prevalence of medication error and quality of prescribing. METHODS Uncontrolled before-after study, undertaken in consecutive adult medical inpatients admitted and discharged alive, using at least three medications. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT intervention involved clinical pharmacists being team-based, leading admission and discharge medication reconciliation and undertaking prescription review. Primary outcome measures were prevalence per patient of medication error and potentially severe error. Secondary measures included quality of prescribing using the Medication Appropriateness Index (MAI) in patients aged ≥65 years. FINDINGS Some 233 patients (112 PACT, 121 standard) were included. PACT decreased the prevalence of any medication error at discharge (adjusted OR 0.07 (95% CI 0.03 to 0.15)); number needed to treat (NNT) 3 (95% CI 2 to 3) and no PACT patient experienced a potentially severe error (NNT 20, 95% CI 10 to 142). In patients aged ≥65 years (n=108), PACT improved the MAI score from preadmission to discharge (Mann-Whitney U p<0.05; PACT median -1, IQR -3.75 to 0; standard care median +1, IQR -1 to +6). CONCLUSIONS PACT, a collaborative model of pharmaceutical care involving medication reconciliation and review, delivered by clinical pharmacists and physicians, at admission, during inpatient care and at discharge was protective against potentially severe medication errors in acute medical patients and improved the quality of prescribing in older patients.
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Affiliation(s)
- Tamasine C Grimes
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Ann Allen
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - John O'Byrne
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - John Barragry
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | - Niall Breslin
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
| | - Eddie Moloney
- Medical Directorate, Tallaght Hospital, Dublin, Ireland
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Ding ST, Wang CL, Huang YH, Shu CC, Tseng YT, Huang CT, Hsu NC, Lin YF, Tsai HB, Yang MC, Ko WJ. Demand and predictors for post-discharge medical counseling in home care patients: a prospective cohort study. PLoS One 2013; 8:e64274. [PMID: 23737976 PMCID: PMC3667835 DOI: 10.1371/journal.pone.0064274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/09/2013] [Indexed: 11/18/2022] Open
Abstract
Rationale Post-discharge care is challenging due to the high rate of adverse events after discharge. However, details regarding post-discharge care requirements remain unclear. Post-discharge medical counseling (PDMC) by telephone service was set-up to investigate its demand and predictors. Methods This prospective study was conducted from April 2011 to March 2012 in a tertiary referral center in northern Taiwan. Patients discharged for home care were recruited and educated via telephone hotline counseling when needed. The patient’s characteristics and call-in details were recorded, and predictors of PDMC use and worsening by red-flag sign were analyzed. Results During the study period, 224 patients were enrolled. The PDMC was used 121 times by 65 patients in an average of 8.6 days after discharge. The red-flag sign was noted in 17 PDMC from 16 patients. Of the PDMC used, 50% (n = 60) were for symptom change and the rest were for post-discharge care problems and issues regarding other administrative services. Predictors of PDMC were underlying malignancy and lower Barthel index (BI). On the other hand, lower BI, higher adjusted Charlson co-morbidity index (CCI), and longer length of hospital stay were associated with PDMC and red-flag sign. Conclusions Demand for PDMC may be as high as 29% in home care patients within 30 days after discharge. PDMC is needed more by patients with malignancy and lower BI. More focus should also be given to those with lower BI, higher CCI, and longer length of hospital stay, as they more frequently have red flag signs.
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Affiliation(s)
- Shih-Tan Ding
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chuan-Lan Wang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Han Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Yu-Tzu Tseng
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Ta Huang
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Feng Lin
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Bin Tsai
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chin Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Je Ko
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Pal A, Babbott S, Wilkinson ST. Can the targeted use of a discharge pharmacist significantly decrease 30-day readmissions? Hosp Pharm 2013; 48:380-8. [PMID: 24421494 PMCID: PMC3839464 DOI: 10.1310/hpj4805-380] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence and cost of hospital readmissions have gained attention. The ability to identify patients at high risk for hospital readmission has implications for quality and costs of care. Medication errors have been shown to increase the risk for readmission. OBJECTIVE To study the impact of a pharmacist-based predischarge medication reconciliation and counseling program on 30-day readmission rates and determine whether polypharmacy and problem medications are important screening criteria. METHODS A prospective, nonrandomized cohort study performed at a single medical-surgical unit with telemetry capability at a single academic medical center. The participants were 729 patients, aged 18 years and older, who were discharged between July 1 and October 29, 2010. The intervention was pharmacist medication reconciliation and counseling based on a screening tool. The primary outcome was 30-day readmission rate. Secondary outcomes were the presence of polypharmacy and problem medications and their relationship with observed 30-day readmission rate, including calculation of a problem med/polypharmacy score. RESULTS The pharmacy review group (n = 537) had a lower 30-day readmission rate than the group receiving usual care (n = 192) (16.8% vs 26.0%; odds ratio [OR] 0.572; 95% CI, 0.387-0.852; P = .006). Polypharmacy, defined as either 5 or more or 10 or more scheduled medications, alone and in combination with at least one problem medication had higher 30-day readmission rates. A score of no factors present exhibited good negative predictive value. CONCLUSIONS Medication reconciliation and counseling by a pharmacist reduced the 30-day readmission rate. Polypharmacy and problem medications appear to have value individually and together. A pharmacist, guided by a screening tool in predischarge medication reconciliation, is one option to effectively reduce 30-day readmissions.
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Affiliation(s)
- Aroop Pal
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - Samaneh Tavalali Wilkinson
- University of Kansas Hospital, Kansas City, Kansas. Corresponding author: Aroop Pal, MD, University of Kansas Medical Center, 6048 Delp, 3901 Rainbow Blvd., Kansas City, KS 66160; phone: 913-588-6005; fax: 913-588-3877; e-mail:
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Simoens S, Spinewine A, Foulon V, Paulus D. Review of the cost-effectiveness of interventions to improve seamless care focusing on medication. Int J Clin Pharm 2011; 33:909-17. [PMID: 21979148 DOI: 10.1007/s11096-011-9563-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 09/05/2011] [Indexed: 11/29/2022]
Abstract
AIM OF THE REVIEW This review of the international literature aims to assess the evidence and its methodological quality relating to the cost-effectiveness of interventions to improve seamless care focusing on medication. METHOD Studies were identified by searching Medline, EMBASE, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, and EconLit up to March 2011 using search terms related to health economics and to seamless care. To be included, economic evaluations had to explore the costs and consequences of an intervention to improve seamless care focusing on medication as compared with usual care. Methodological quality of studies was assessed by considering perspective; design; source of clinical and economic data; cost and consequence measures; allowance for uncertainty; and incremental analysis. Costs were actualized to 2007 values. RESULTS Eight studies on medication interventions for hospitalized patients in the transition between ambulatory and hospital care were included in the review. A variety of types of medication interventions and target populations have been assessed, but the evidence is limited to one economic evaluation for each particular intervention type and each specific target population. Most studies demonstrated an impact of interventions on compliance and (re)hospitalization rates and costs. The studies did not find an impact on quality of life or symptoms. Economic evaluations suffered from methodological limitations related to the narrow perspective; restriction to health care costs only; exclusion of costs of the intervention; use of intermediate consequence measures; no allowance for uncertainty; and absence of incremental analysis. CONCLUSION In light of the small number of economic evaluations and their methodological limitations, it is not possible to recommend a specific intervention to improve seamless care focusing on medication on health economic grounds.
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Affiliation(s)
- Steven Simoens
- Research Centre for Pharmaceutical Care and Pharmaco-economics, Katholieke, Universiteit Leuven, Onderwijs en Navorsing 2, Herestraat 49, P.O. Box 521, 3000, Leuven, Belgium.
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Abstract
The purpose of this study was to evaluate a transitional care intervention posthospital discharge for chronically ill medical patients managing complex medication regimens. This descriptive pilot study tested 2 interventions: telephone follow-up and a home visit. Registered nurses delivered the interventions with consulting pharmacist support. Findings included 62% more medication discrepancies discovered during home visit than detected by telephone interview. This brief intervention identified significant knowledge gaps in self-management of discharge medications in the inner city population.
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Affiliation(s)
- Michelle Mourad
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, 505 Parnassus Ave, M1287, Box 0131, San Francisco, CA 94143 USA
| | - Josh Adler
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA USA
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