Improving Transplant Medication Safety Through a Technology and Pharmacist Intervention (ISTEP): Protocol for a Cluster Randomized Controlled Trial

Results of a multicenter cluster-randomized controlled clinical trial testing the effectiveness of a bioinformatics-enabled pharmacist intervention in transplant recipients

An ambulatory medication safety dashboard was developed to identify missing labs, concerning labs, drug interactions, nonadherence, and transitions in care. This system was tested in a 2-year, prospective, cluster-randomized, controlled multicenter study. Pharmacists at 5 intervention sites used the dashboard to address medication safety issues, compared with usual care provided at 5 control sites. A total of 2196 transplant events were included (1300 intervention vs 896 control). During the 2-year study, the intervention arm had a 11.3% (95% confidence interval, 7.1%-15.5%) absolute risk reduction of having ≥1 emergency department (ED) visit (44.2% vs 55.5%, respectively; P < .001, respectively) and a 12.3% (95% confidence interval, 8.2%-16.4%) absolute risk reduction of having ≥1 hospitalization (30.1% vs 42.4%, respectively; P < .001). In those with ≥1 event, the median ED visit rate (2 [interquartile range (IQR) 1, 5] vs 2 [IQR 1, 4]; P = .510) and hospitalization rate (2 [IQR 1, 3] vs 2 [IQR 1, 3]; P = .380) were similar. Treatment effect varied by comorbidity burden, previous ED visits or hospitalizations, and heart or lung recipients. A bioinformatics dashboard-enabled, pharmacist-led intervention reduced the risk of having at least one ED visit or hospitalization, predominantly demonstrated in lower risk patients.

Feasibility study and determination of prerequisites of telecare programme to enhance patient management in lung transplantation: a qualitative study from the perspective of Iranian healthcare providers

BACKGROUND

Non-adherence to treatment plans, follow-up visits and healthcare advice is a common obstacle in the management of lung transplant patients. This study aims to investigate experts' views on the needs and main aspects of telecare programmes for lung transplantation.

DESIGN

A qualitative study incorporating an inductive thematic analysis.

SETTING

Lung transplant clinic and thoracic research centre.

PARTICIPANTS

Clinicians: four pulmonologists, two cardiothoracic surgeons, two general physicians, two pharmacotherapists, one cardiologist, one nurse and one medical informatician.

METHOD

This study adopted a focus group discussion technique to gather experts' opinions on the prerequisites and features of a telecare programme in lung transplantation. All interviews were coded and combined into main categories and themes. Thematic analysis was performed to extract the key concepts using ATLAS.Ti. Ultimately, all extracted themes were integrated to devise a conceptual model.

RESULTS

Ten focus groups with 13 participants were conducted. Forty-six themes and subthemes were extracted through the thematic analysis. The main features of the final programme were extracted from expert opinions through thematic analysis, such as continuous monitoring of symptoms, drug management, providing a specific care plan for each patient, educating patients module, creating an electronic medical record to collect patient information, equipping the system with decision support tools, smart electronic prescription and the ability to send messages to the care team. The prerequisites of the system were summarised in self-care activities, clinician's tasks and required technologies. In addition, the barriers and benefits of using a telecare system to enhance the quality of care were determined.

CONCLUSION

Our investigation recognised the main factors that must be considered to design a telecare programme to provide ideal continuous care for lung transplant patients. Users should further explore the proposed model to support the development of telecare interventions at the point of care.

Virtual clinical pharmacy services: A model of care to improve medication safety in rural and remote Australian health services

Purpose

To describe a virtual clinical pharmacy service as a model of care to support rural and remote Australian hospitals that otherwise would not have access to onsite pharmacists.

Summary

Many small hospitals in Australia do not have an onsite hospital pharmacist and struggle to support and optimize patient care. To increase access to a hospital pharmacist’s specialized skills and medication knowledge, a virtual clinical pharmacy service was designed and implemented in 8 hospitals across rural New South Wales, Australia in 2020. The virtual clinical pharmacy service focuses on the core role of hospital pharmacists, including obtaining a best possible medication history, medication reconciliation at transitions of care, medication review, interprofessional team meetings, provision of patient-friendly medication lists, antimicrobial stewardship, and patient and clinician education. The model is aligned with recognized standards of practice for the delivery of clinical pharmacy services in Australian hospitals. This article details a model of care for translation across other settings. It provides the necessary details on clinical services, processes, supporting structures, an evaluation framework, and other important considerations for implementing virtual pharmacy services.

Conclusion

This research provides policymakers, health service planners, and practitioners with a model for providing comprehensive clinical pharmacy services virtually to increase the safe and effective use of medicines. Future publication of the findings of a formal evaluation of the model’s acceptability and effectiveness is planned.