Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

Abstract

Background:After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known.Objective:This study aims to a) Identify community pharmacists’ current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists’ objectives and ideas for discharge optimisation.Methods:A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies.Results:The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient’s care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation.There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services.Conclusion:Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist’s opinions, appropriate pharmaceutical care is therefore impeded.

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

“…Subsequently, patients reported this intentional stop to the community pharmacist during the medication review. The lack of communication between community pharmacists and physicians create issues with care transitions and was identified as a potential risk for patient safety [32,33]. Eggink and colleagues [34] reported that a clinical pharmacist-led discharge service consisting of a medication review, verbal and written information for the patient, and a discharge list with additional information related to medication, decreased the number of prescription errors and medication discrepancies in patients with heart failure.…”

Medication management surrounding transitions of care: A qualitative assessment of community pharmacists’ preferences (MEMO TOC)

“…5,6 Community pharmacists perceive the lack of communication between hospital and community as a barrier to providing optimal patient care at this point of transition. [6][7][8][9][10] Community pharmacists are often underinformed about changes in patients' medications or medical problems diagnosed during the hospitalization, as discontinued medications or dose changes are not explicitly indicated or rationalized. 10 Community pharmacists provide medication consultation, education and guidance to patients; Hassell et al 11 found that patients often prefer the pharmacists' advice to that of their general practitioner.…”

“…16 Other information community pharmacists reported being useful in assessing medication therapy after hospital discharge includes the reason for medication changes, allergies, specifications for "off-label" medication use, laboratory information, or contact information of the prescriber. 7,8 Brühwiler et al 7 found that many community pharmacists judged their ability to manage patient medication therapy, monitor patient progress and outcomes as "(rather) bad" following hospital discharge. There is need for efficient exchange of information at discharge to provide for better provision of care to patients by community pharmacists.…”

Comment to: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

“…addresses significant health systems gaps in communications and transitions of care when patients follow up at community pharmacies following discharge from hospitals. 1 The authors also report on needs and perceptions of community pharmacists in their role to guide optimal patient care. While the authors aptly highlight the need for improvement in care, tangible actions that providers, community pharmacists, and institutions can adopt to accomplish this goal are not fully elaborated.…”

“… 2 These errors are attributed in part to communication barriers such as inaccessibility of discharge providers, and can lead to increased readmissions, morbidity and mortality. 1 As such, discharging providers must ensure that they actively engage and communicate with community pharmacists. 3 Ensuring easy and reliable access to hospital providers and patient information on discharge by building relationships with local hospitals, and establishing secure next-generation technological systems for bridging communication between community pharmacists and hospital providers should be pursued.…”