A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions

Abstract

Objective To improve discharge prescription quality and information transfer to improve posthospital care with a pragmatic in-hospital service. Design A single-centre, randomized controlled trial Setting Internal medicine wards in a Swiss teaching hospital Participants Adult patients discharged to their homes, 76 each in the intervention and control group. Intervention Medication reconciliation at discharge by a clinical pharmacist, a prescription check for formal flaws, interactions and missing therapy durations. Important information was annotated on the prescription. Main Outcome Measures : At the time of medication dispensing, community pharmacy documented their pharmaceutical interventions when filling the prescription. A Poisson regression model was used to compare the number of interventions (primary outcome). The significance of the pharmaceutical interventions was categorized by the study team. Comparative analysis was used for the significance of interventions (secondary outcome). Results The community pharmacy staff performed 183 interventions in the control group, and 169 in the intervention group. The regression model revealed a relative risk for an intervention of 0.78 (95% CI 0.62-0.99, p=0.04) in the intervention group. The rate of clinically significant interventions was lower in the intervention group than in the control group (72 of 169 (42%) vs. 108 of 183 (59%), p<0.01), but more economically significant interventions were performed (98, 58% vs. 80, 44%, p<0.01). Conclusions The pragmatic in-hospital service increased the quality of prescriptions. The intervention group had a lower risk for the need for pharmaceutical interventions, and clinically significant interventions were less frequent. Overall, our pragmatic approach showed promising results to optimize post-discharge care.

Medication review interventions to reduce hospital readmissions in older people

“…Study size ranged from 22 to 4,049, over half (n = 21, 84%) of included studies had a study population ≥ 100. [25][26][27][28][29][30][31][32][33]35,[39][40][41][42][43][44][45][46][47][48][49] The mean/median number of regularly used medication was at least 6 and in most studies ranged between 6 and 10 (n = 18, 72%). [25][26][27][28][29][30]32,33,35,[37][38][39][40]43,44,[46][47][48] A summary of the characteristics of the medication review interventions is provided in Table S5.…”

“…25,26,[28][29][30][32][33][34][35][36][37][39][40][41][45][46][47] In 19 studies (76%) there was a high risk of bias for contamination. [25][26][27][28][29][31][32][33][34][36][37][38][39][40]42,45,[47][48][49] For the domains "incomplete outcome data" (n = 16, 64%) 25,[27][28][29][30][31][32][33][34][35][36][37][38]40,42,47 and "selective outcom...…”

“…For the outcome "at least one all-cause hospital readmission within 30 days after discharge," the NMA included 11 studies (7,318 participants) 30,31,[33][34][35]40,44,[46][47][48][49] and 10 interventions that were all compared with usual care ( Figure S3). Each intervention was directly compared to usual care, except for the medication review intervention without any co-interventions, for which only indirect evidence was present.…”

“…For the outcome "at least one all-cause hospital readmission at any time," the NMA included 24 studies (11,677 participants) [25][26][27][28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][44][45][46][47][48][49] and 17 interventions ( Figure S4). All interventions consisting of multiple components were compared with usual care.…”

Medication Discrepancies in Community Pharmacies in Switzerland: Identification, Classification, and Their Potential Clinical and Economic Impact

“…A pragmatic pharmacist-led in-hospital service consisting of medication reconciliation, addition of information regarding therapy changes (new, stop, change in dose), and check of the prescription for formal mistakes reduced clinically significant pharmaceutical interventions. Moreover, pharmacists' satisfaction with the quality of the discharge prescription were significantly higher in the group with the in-hospital service [37]. The performance of a systematic medication reconciliation as part of a medication review in community pharmacies is also a chance to update the community pharmacy patient records and the patient's home medication list.…”