A pharmacy discharge plan for hospitalized elderly patients—a randomized controlled trial

Nazareth, Irwin; Burton, Ann; Shulman, Sally; Smith, Paul D.; Haines, Andy; Timberall, Heather

doi:10.1093/ageing/30.1.33

Cited by 153 publications

(205 citation statements)

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“…40 Home visits by clinical pharmacists in one trial of 872 discharged patients 80 years or older, despite changes in management of 20% of participants, resulted in a 30% increase (P = 0.009) in readmissions, 41 whereas in another trial involving 362 medical patients, no impact on readmissions was noted. 42 One trial reported significantly reduced adverse drug events as a consequence of pharmacist counselling of patients following discharge but no change in readmissions. 43 Two trials involving 334 patients with chronic lung disease failed to show any impact of nurse home visits on readmissions, 44,45 in contrast to two trials involving 878 patients with cardiac disease that demonstrated a significant (P < 0.05) one-third decrease in readmissions.…”

Section: Post-discharge Home Visits or Telephonic Follow-upmentioning

confidence: 99%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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Background. Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.Objective. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre-and postdischarge elements.Design. Systematic metareview of controlled trials. Data collection. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.Data synthesis. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.Conclusion. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre-and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospitalcommunity interface.What is known about this topic? Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre-and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add? With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers? Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow succ...

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Section: Post-discharge Home Visits or Telephonic Follow-upmentioning

confidence: 99%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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“…Among evaluations conducted by means of comparison trials, there have been discrepancies, with some authors reporting higher patient satisfaction among those who received the intervention being studied than among those who received no intervention (i.e., usual care), 12,16 and other authors reporting no difference in satisfaction between those who received the pharmacy services intervention and those who received usual care. 21,22 In both of the studies in which patient satisfaction with pharmacy services was higher in the intervention group than the nonintervention group, the survey was developed specifically for the evaluation and was based on literature and the project itself. 12,16 In one of the studies in which satisfaction was not higher in the intervention group, 22 the survey used to assess patient satisfaction 23 had been developed to assess health services in general, not pharmacy services in particular.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction Survey for a Medication Management Program: Satisfaction Guaranteed?

Flanagan

Kainth

Nissen

2013

CJHP

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Background: Providing clinical pharmacy services to patients in their homes after discharge from hospital has been reported to reduce health care costs and improve outcomes. The Medication Management Program of the Fraser Health Authority involves pharmacists making home visits to provide clinical pharmacy services to elderly patients who have recently been discharged from hospital and others considered to be at high risk for adverse drug events. Although clinical and economic outcomes of this program have been evaluated, humanistic outcomes such as satisfaction have not been assessed. Moreover, very little evaluation of patient satisfaction with home pharmacy services has been reported in the literature.

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“…[11][12][13][14][15]18 This may be due to the variability in the types of pharmacist intervention provided, the cultural climate of the health system being studied, or many other factors. One possible reason for this is that the pharmacist plays an important role, but other team members, such as care coordinators and nurse educators, also need to be added to the patient's care team to have a more significant impact in reducing hospital readmissions.…”

Section: 10mentioning

confidence: 99%

Evaluation of the Impact of Comprehensive Medication Management Services Delivered Posthospitalization on Readmissions and Emergency Department Visits

Westberg¹,

Swanoski²,

Renier³

et al. 2014

JMCP

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A pharmacy discharge plan for hospitalized elderly patients—a randomized controlled trial

Abstract: we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes.

Cited by 153 publications

References 0 publications

Preventing the rebound: improving care transition in hospital discharge processes

Preventing the rebound: improving care transition in hospital discharge processes

Satisfaction Survey for a Medication Management Program: Satisfaction Guaranteed?

Evaluation of the Impact of Comprehensive Medication Management Services Delivered Posthospitalization on Readmissions and Emergency Department Visits

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