Effects of Hospital-Based Comprehensive Medication Reviews Including Postdischarge Follow-up on Older Patients’ Use of Health Care

Kempen, Thomas; Bertilsson, Maria; Hadziosmanovic, Nermin; Lindner, Karl‐Johan; Melhus, Håkan; Nielsen, Elisabet I.; Sulku, Johanna; Gillespie, Ulrika

doi:10.1001/jamanetworkopen.2021.6303

Cited by 36 publications

(55 citation statements)

References 47 publications

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“…Patients were selected from a multicentre, cluster-randomised, crossover trial (MedBridge) conducted between 2017 and 2018 at four Swedish hospitals: the hospitals in Uppsala, Enköping, Västerås and Gävle [ 28 ]. The aim of the trial was to study the effects of pharmacist-initiated hospital-based CMRs, including active follow-up, on older patients’ healthcare utilisation.…”

Section: Methodsmentioning

confidence: 99%

“…A total number of 2637 patients were included. The incidence of unplanned hospital revisits within 12 months did not differ between the intervention groups and the control group [ 28 ]. A process evaluation of the trial [ 29 ] showed that in less than half of the intervention patients (46%), the CMR included a medication reconciliation at discharge.…”

Section: Methodsmentioning

confidence: 99%

“…Values in each box are numbers of patients. * A multicentre, cluster-randomised, crossover trial [ 28 ] …”

Section: Methodsmentioning

confidence: 99%

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Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

et al. 2021

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Background The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. Methods We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. Results A total of 699 patients were included. The patients’ mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). Conclusions The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

et al. 2021

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“…Nonetheless, the follow-up has gained increased attention over the last decade. In Sweden, the Medbridge trial [ 21 ] investigated the effects of hospital-based comprehensive medication reviews where one arm included post-discharge follow-ups, but found no effect on patients’ unplanned hospital visits within 12 months when compared to a control group. In contrast, a Danish study of a similar intervention explicitly used the patient-centred technique of motivational interviewing in their follow-up; they found that readmissions within 30 and 180 days were decreased among patients who received medication reviews and follow-up [ 22 ].…”

Section: Commentarymentioning

confidence: 99%

Commentary: how person-centred is pharmaceutical care?

2021

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Health systems in many countries are currently undergoing an evolution towards more person-centred care. However, an overview of the literature shows that there is little or no guidance available on how to apply person-centred care to pharmaceutical care and clinical pharmacy practices. In this paper we apply a model for person-centred care created by a national multidisciplinary research centre in Gothenburg, Sweden, to the clinical work tasks of outpatient and inpatient pharmacists and describe how pharmaceutical care can become more person-centred.

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“…Recent trials on the effectiveness of pharmacy-led TOC initiatives have used a variety of pharmacy-led intervention components with mixed results. The Medication Reviews Bridging Healthcare (MedBridge) trial conducted by Kempen et al [ 15 ] evaluated the effect of two distinct pharmacist-led interventions, a comprehensive medication review (CMR) and CMR with detailed and structured post discharge follow-up, on the primary endpoint of emergency department attendances and admissions. The results of the MedBridge trial failed to show a significant difference between standard care and intervention groups.…”

Section: Introductionmentioning

confidence: 99%

A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework

Murry

Keller

Pevnick

et al. 2022

BMC Health Serv Res

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Introduction Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention. Methods Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding. Results In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention. Conclusion The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability. Trial registration NCT04071951.

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Effects of Hospital-Based Comprehensive Medication Reviews Including Postdischarge Follow-up on Older Patients’ Use of Health Care

Cited by 36 publications

References 47 publications

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

Commentary: how person-centred is pharmaceutical care?

A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework

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