Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward.
- Neeman M Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland.
- Dobrinas M Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland.
- Maurer S Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland; Pharmacie du Marché, Vevey, Switzerland.
- Tagan D Hôpital Riviera-Chablais, Vaud-Valais (HRC), Vevey, Switzerland.
- Sautebin A Hôpital Riviera-Chablais, Vaud-Valais (HRC), Vevey, Switzerland.
- Blanc AL Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland. Electronic address: annelaure.blanc@phel.ch.
- Widmer N Pharmacie des Hôpitaux de l'Est Lémanique (PHEL), Vevey, Switzerland; Division of Clinical Pharmacology, Lausanne University Hospital, Lausanne, Switzerland.
- 2016-11-29
Published in:
- European journal of internal medicine. - 2017
Clinical pharmacist
Community pharmacy
Discharge planning
Hospital discharge prescription
Medication reconciliation
Transition of care
Adult
Aged
Aged, 80 and over
Case-Control Studies
Female
Humans
Internal Medicine
Male
Medication Reconciliation
Middle Aged
Patient Admission
Patient Discharge
Patient Transfer
Pharmacies
Pharmacists
Pharmacy Service, Hospital
Professional Role
Switzerland
English
BACKGROUND
Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care.
METHODS
This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes.
RESULTS
Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (p<0.0001); less time working on discharge prescriptions; less interventions requiring a telephone call to a hospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (p<0.0001) changes between hospital admission and discharge, 66% fewer (p<0.0001) between hospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner.
CONCLUSION
An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care.
Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care.
METHODS
This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes.
RESULTS
Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (p<0.0001); less time working on discharge prescriptions; less interventions requiring a telephone call to a hospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (p<0.0001) changes between hospital admission and discharge, 66% fewer (p<0.0001) between hospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner.
CONCLUSION
An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.ejim.2016.11.004
- PMID 27890453
- Persistent URL
- https://sonar.ch/global/documents/20508
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