The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review

Background

Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear.

Aims

To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist.

Methods

Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes.

Results

Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported.

Conclusions

A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.

Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease: A Comprehensive Review

Cardiovascular diseases are a major cause of death worldwide, and coronary heart disease (CHD) is a prevalent cardiovascular condition and a significant health burden for the population. In this disease, insufficient blood flow to the heart due to plaque accumulation in the coronary arteries causes chest pain, heart attack, and even death. So, it is vital to identify risk factors, prevention, appropriate treatment, and rehabilitation. Nurses play an indispensable role in managing and caring for patients with CHD. Indeed, they possess a deep understanding of the disease and its complexities, enabling them to provide comprehensive care to patients. Nurses monitor vital signs, administer medications, and perform diagnostic tests, ensuring patients receive timely and appropriate interventions. They also educate patients and their families about CHD, emphasizing lifestyle modifications, medication adherence, and self-care practices. Moreover, nurses offer emotional support, guiding patients through the physical and psychological challenges associated with CHD. Their expertise, compassion, and dedication significantly improve patient outcomes and overall quality of life. Nurses are responsible for assessing, diagnosing, and counseling patients on how to manage their disease, making them the front line of defense in preventing and addressing this serious condition. In the current study, we reviewed the literature to consider the best practices and emerging trends in nursing interventions and care strategies for patients with CHD.

The Effectiveness of Family Medicine-Driven Interprofessional Collaboration on the Readmission Rate of Older Patients

Interprofessional collaboration (IPC) for older patient care among family physicians, dentists, therapists, nutritionists, nurses, and pharmacists in the rural hospital care of older patients could improve the hospital readmission rate. However, there is a lack of interventional studies on IPC for improving the readmission rate among Japanese older patients in rural hospitals. This quasi-experimental study was performed on patients >65 years who were discharged from a rural community hospital. The intervention was IPC implementation with effective information sharing and comprehensive management of older patients’ conditions for effective discharge and readmission prevention; implementation started on 1 April 2021. The study lasted 2 years, from 1 April 2021 to 31 March 2022 for the intervention group and from 1 April 2020 to 31 March 2021 for the comparison group. The average participant age was 79.86 (standard deviation = 15.38) years and the proportion of men was 45.0%. The Cox hazard model revealed that IPC intervention could reduce the readmission rate after adjustment for sex, serum albumin, polypharmacy, dependent condition, and Charlson Comorbidity Index score (hazard ratio = 0.66, 95% confidence interval: 0.54−0.81). Rural IPC intervention can improve inpatient care for older patients and decrease readmission rates. Thus, for effective rural IPC interventions, family physicians in hospitals should proactively collaborate with various medical professionals to improve inpatient health outcomes.

Improving transitional care through online communication skills training

Background

As the aging population is increasing significantly, the communication skills training (CST) on transitional care (TC) is insufficient.

Aims

This study aimed to test the effectiveness of an intervention (the online TC CST [OTCCST] and TC) through the perspectives of healthcare providers (HCPs), older patients, and family members.

Methods

A total of 38 HCPs caring for older patients were randomized to the experimental (n = 18) or control groups (n = 20), and 84 pairs of patients and family members were enrolled (experimental: n = 42 vs. control: n = 42). The primary outcome was HCP communication confidence; while secondary outcomes included patient quality of life (QoL), activities of daily living (ADL), rehospitalization counts, and family caregiving burden. Data were collected from HCPs using a scale measuring confidence in communicating with patients. Patient outcomes were assessed using the McGill QoL Questionnaire-Revised and Barthel Index. Family members were assessed with the Caregiver Burden Inventory. Rehospitalization counts were tracked for 3 months post-discharge. Data were analyzed using multiple regression analysis.

Results

Experimental group HCPs showed a significant improvement in communication confidence over the control group (p = 0.0006). Furthermore, experimental group patients had significantly fewer rehospitalization counts within 3-month post-discharge (p < 0.05). However, no significant group differences were found in patient QoL and ADL nor in family caregiver burden.

Conclusion

The OTCCST can effectively improve HCP communication confidence, and the combination of OTCCST and TC can reduce rehospitalization counts for older patients. The OTCCST allows HCPs to learn asynchronously at their convenience, ideal for continuing education, especially during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-022-02251-4.

Assessing the Impact of an Advanced Clinical Decision Support System on Medication Safety and Hospital Readmissions in an Innovative Transitional Care Model: A Pilot Study

(1) Background: Adverse drug events and inappropriate use of medications lead to hospitalizations, medication-related morbidity, and mortality. This study examined whether a novel medication risk prediction tool, the MedWise Risk Score™, was associated with medication safety-related problem (MRP) identification and whether integration into an existing innovative transitions of care (TOC) service could decrease readmissions. (2) Methods: This retrospective comparator group study assessed patients discharged from a hospital in southern Arizona between January and December 2020. Participants were included in the study if they were 18 years of age or older, referred to the pharmacist for TOC services, and received a pharmacist consultation within one-week post discharge. Patients were categorized into two groups: (1) medication safety review (MSR)-TOC service (intervention) or (2) existing innovative TOC service (control). (3) Results: Of 164 participants, most were male (57%) and were between 70−79 years of age. Overall, there were significantly more drug-drug interactions (DDI) MRPs identified per patient in the intervention vs. control group for those who were readmitted (3.7 ± 1.5 vs. 0.9 ± 0.6, p < 0.001) and those who were not readmitted (2 ± 1.3 vs. 1.3 ± 1.2, p = 0.0120). Furthermore, of those who were readmitted, the average number of identified MRPs per patient was greater in the intervention group compared to the control (6.3 vs. 2.5, respectively, p > 0.05). Relative to the control, the readmission frequency was 30% lower in the treatment group; however, there was insufficient power to detect significant differences between groups. (4) Conclusions: The integration of a medication risk prediction tool into this existing TOC service identified more DDI MRPs compared to the previous innovative TOC service, which lends evidence that supports its ability to prevent readmissions. Future work is warranted to demonstrate the longitudinal impact of this intervention in a larger sample size.

Transit Care Hub pharmacist: improving patient flow within the hospital

Background The Transit Care Hub (TCH) is an inpatient ward traditionally used as a waiting area for patients who require transport to return home. In July 2018, a six-month pilot of a TCH pharmacist was funded to improve the flow of patients through the hospital. Setting Major Australian teaching hospital. Objective(s) To determine the effect that the TCH pharmacist had on patient flow within the hospital and on the time saved for other clinical pharmacists, as well as estimating cost savings. Methods A service delivery framework for the TCH pharmacist was developed and tested. This involved a proactive approach to patient discharge with ward-based staff. Data were collected from July to November 2018, 20 weeks prior to and 20 weeks after the commencement of the pilot. Main outcome measure Measurements included the number of best possible medication histories (BPMHs) completed during admission, improvements in arrival time to TCH from inpatient wards and cost savings. Results During the pilot study period (20 weeks), 791 patients were discharged by the TCH pharmacist, arriving an average of 70 minutes earlier than other patients discharging through TCH. There was a 16% increase in patients discharging through TCH which released ward beds. The TCH pharmacist increased the number of BPMHs on day of admission by 14%. There was an estimated annual saving of AU$252,008 for the hospital. Conclusions The TCH pharmacist service enhanced patient flow by coordinating earlier discharges, increasing the timely completion of BPMHs, and saving ward pharmacist time. Significant cost savings supported a permanently funded position.

Traversing the Quality Chasm: Revisiting the Framework for Pharmacy Services Quality Improvement

DISCLOSURES

No funding supported the writing of this reflection. The authors have nothing to disclose.