The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before—After prospective study

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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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Most cited references 39

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Role of pharmacist counseling in preventing adverse drug events after hospitalization.

C. Roy, Allen Kachalia, M Horng … (2006)

Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P = .01). No differences were found between groups in total ADEs or total health care utilization. Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.

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National surveillance of emergency department visits for outpatient adverse drug events.

Daniel S Budnitz, Daniel A Pollock, Kelly Weidenbach … (2006)

Adverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited. To describe the frequency and characteristics of adverse drug events that lead to emergency department visits in the United States. Active surveillance from January 1, 2004, through December 31, 2005, through the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project. National estimates of the numbers, population rates, and severity (measured by hospitalization) of individuals with adverse drug events treated in emergency departments. Over the 2-year study period, 21,298 adverse drug event cases were reported, producing weighted annual estimates of 701,547 individuals (95% confidence interval [CI], 509,642-893,452) or 2.4 individuals per 1000 population (95% CI, 1.7-3.0) treated in emergency departments. Of these cases, 3487 individuals required hospitalization (annual estimate, 117,318 [16.7%]; 95% CI, 13.1%-20.3%). Adverse drug events accounted for 2.5% (95% CI, 2.0%-3.1%) of estimated emergency department visits for all unintentional injuries and 6.7% (95% CI, 4.7%-8.7%) of those leading to hospitalization and accounted for 0.6% of estimated emergency department visits for all causes. Individuals aged 65 years or older were more likely than younger individuals to sustain adverse drug events (annual estimate, 4.9 vs 2.0 per 1000; rate ratio [RR], 2.4; 95% CI, 1.8-3.0) and more likely to require hospitalization (annual estimate, 1.6 vs 0.23 per 1000; RR, 6.8; 95% CI, 4.3-9.2). Drugs for which regular outpatient monitoring is used to prevent acute toxicity accounted for 41.5% of estimated hospitalizations overall (1381 cases; 95% CI, 30.9%-52.1%) and 54.4% of estimated hospitalizations among individuals aged 65 years or older (829 cases; 95% CI, 45.0%-63.7%). Adverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies.

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Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission

Jesper Hallas, Anton Pottegård, Lene Vestergaard Ravn-Nielsen … (2018)

Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society.

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Author and article information

Contributors

Sara Daliri:

ORCID: http://orcid.org/0000-0003-3999-3444

Role: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: ValidationRole: Writing – original draft

Jacqueline G. Hugtenburg: Role: ConceptualizationRole: MethodologyRole: Writing – review & editing

Gerben ter Riet: Role: Formal analysisRole: MethodologyRole: Writing – review & editing

Bart J. F. van den Bemt: Role: ConceptualizationRole: MethodologyRole: Writing – review & editing

Bianca M. Buurman: Role: SupervisionRole: Writing – review & editing

Wilma J. M. Scholte op Reimer: Role: SupervisionRole: Writing – review & editing

Marie-Christine van Buul-Gast: Role: Supervision

Fatma Karapinar-Çarkit: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing

Meagen Rosenthal: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 12 March 2019

Publication date Collection: 2019

Volume: 14

Issue: 3

Electronic Location Identifier: e0213593

Affiliations

[1 ] Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

[2 ] Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands

[3 ] Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands

[4 ] Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, the Netherlands

[5 ] Community Pharmacy Westwijk, Amsterdam, the Netherlands

[6 ] Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands

[7 ] Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands

[8 ] Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands

[9 ] Department of Pharmacy, University Medical Centre Maastricht, the Netherlands

[10 ] Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands

[11 ] Department of Hospital Pharmacy, BovenIJ Hospital, Amsterdam, the Netherlands

University of Mississippi, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: s.daliri@ 123456hva.nl (SD); f.karapinar@ 123456olvg.nl (FKÇ)

Author information

Sara Daliri http://orcid.org/0000-0003-3999-3444

Article

Publisher ID: PONE-D-18-24125

DOI: 10.1371/journal.pone.0213593

PMC ID: 6413946

PubMed ID: 30861042

SO-VID: a8e62fd5-7577-4b91-9255-b931f4ccc018

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 9 October 2018

Date accepted : 25 February 2019

Page count

Figures: 2, Tables: 3, Pages: 17

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100001826, ZonMw;

Award ID: 836044008

Award Recipient : Fatma Karapinar-Çarkit

F. Karapinar-Çarkit received a research grant of 84 thousand euros from the Netherlands Organisation for Health Research and Development (ZonMw), grant no: 836044008: https://www.zonmw.nl/nl/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before—After prospective study

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Abstract

Background

Methods

Results

Conclusions

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PLOS Climate

Most cited references 39

Role of pharmacist counseling in preventing adverse drug events after hospitalization.

National surveillance of emergency department visits for outpatient adverse drug events.

Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission

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Contributors

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Cited by 27

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