Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial

Bouchand, Frédérique; Leplay, Céline; Guimarães, Ricardo Lima; Fontenay, Sarah; Fellous, Lesly; Dinh, Aurélien; Deconinck, Laurène; Sénard, Olivia; Matt, Morgan; Michelon, Hugues; Perronne, Christian; Salomon, Jérôme; Villart, M.; Izedaren, Fatima; Pottier, Sandra; Barbot, Frédéric; David, Olivier; Vaugier, Isabelle

doi:10.1111/ijcp.14282

Cited by 4 publications

(11 citation statements)

References 20 publications

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“…Following title and abstract screening, 274 full texts were retrieved. A total of 126 RCTs involving 97 408 participants met our inclusion criteria (Figure 2). The study characteristics are presented in eAppendix 3 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…Pooling data from the 73 studies (85 direct comparisons) involving 77 201 participants, low-complexity (OR, 0.78; 95% CI, 0.66 to 0.92) and medium-complexity (OR, 0.82; 95% CI, 0.68 to 0.97) interventions were associated with decreased odds of readmission at 30 days compared with usual care (Figure 3; eAppendix 2 in Supplement 1). High-intensity interventions were not associated with reductions in readmissions (OR, 0.96; 95% CI, 0.80 to 1.15).…”

Section: Resultsmentioning

confidence: 99%

“…High-complexity interventions were associated with reducing some health care utilization outcomes, but their associations were less pronounced. Moreover, we obtained preliminary evidence from pairwise meta-analysis that medium-complexity interventions might be best for reducing patient and medication harms (ie, adverse events 11,102,104,134,138 and medication adherence 44,93,94,103,130,134,138 ) whereas highcomplexity interventions might be best for improving patient satisfaction. 9,74,81,91,105,133,143 In general, the intervention complexity did not affect the intervention uptake; the only exception was that the uptake of medium-complexity interventions might be lower in low-resource settings, such as…”

Section: Discussionmentioning

confidence: 99%

“…Most trials reported hospital readmissions and, at best, some additional health care utilization outcomes (eg, ED visits, 7, 9, 29-31, 34, 35, 37, 39, 47-50, 52, 56-58, 60, 61, 67, 68, 73, 78, 80, 87, 88, 94, 102, 105, 106, 113, 115, 119, 121, 125, 130, 132, 137, 145, 146, 148 length of hospital stay 8,13,30,38,43,51,55,56,65,71,72,74,80,87,89,90,99,101,109,110,112,121,126 ), and adverse outcomes (mortality 7, 9, 10, 12, 32, 35, 37, 39, 40, 44, 47, 48, 56, 57, 70, 76-79, 83, 89, 91-94, 97, 98, 100, 106, 110, 111, 114, 116, 121, 123, 125, 127, 137, 139, 141, 142, 148 ). Few trials have measured patient-reported outcomes (eg, QOL 9, 32, 38, 44, 56, 65, 66, 83-85, 91, 97, 105, 107, 110, 112, 114, 123, 125, 126, 132, 133, 140, 141, 145, 148 and patient satisfaction with the transitional care 7,9,13,32,43,62,67,74,80,81,91,105,115,130,133,143 ) and broader risks for patient harm and safety 11,…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

“…Some interventions include multiple components, implemented mainly prior to discharge but some also after discharge, and/or involve a care coordinator or case manager . Other less-intensive interventions target 1 key challenge of the discharge process (eg, medication safety) at 1 stage of the discharge process . A number of systematic reviews suggest that various transitional care interventions are promising for improving health care utilization and possibly patient outcomes .…”

Section: Introductionmentioning

confidence: 99%

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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Improving inpatient discharge workflows through pharmacist pending discharge medication orders

Lee

Nixon

Niemi

et al. 2023

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hospital discharge represents a difficult care transition for patients, with the potential for medication-related problems (MRPs) and adverse events. Medication reconciliation is widely accepted as a best practice to minimize MRPs at the time of discharge. Pharmacists can play a key role in identification and resolution of MRPs, although pharmacist reconciliation usually occurs after provider medication reconciliation. This workflow is often inefficient and results in duplication of work within the care team. A prospective pharmacist-led pilot program with preparation of discharge medication orders for provider review, also known as pended medication orders, was investigated to determine its impact on MRPs and discharge processing time. Summary Patient discharges from February through April 2022 were compared for 2 hospital medicine services at a large academic medical center. One group participated in the pilot workflow, while the other used standard discharge workflows. The pilot group had a significant decrease in the average number of clinical interventions made by a pharmacist after provider orders were placed (52.4% decrease; P = 0.03) and a nonsignificant reduction in the time from provider order entry to completion of the final pharmacist medication reconciliation (47.6% reduction; P = 0.18) compared to the group using standard workflows. Conclusion Pharmacist-led, prospective discharge medication reconciliation with pending of medication orders for provider review increases overall discharge efficiency. Data from this project and previous studies support an expanded pharmacist role in the discharge process and continued high-level collaboration between pharmacists and providers.

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Importância do farmacêutico na alta hospitalar qualificada: Revisão integrativa

Amorim,

Santos

2023

RSD

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A alta hospitalar é definida como a saída do paciente do ambiente hospitalar e envolve demandas assistenciais geradas durante a internação, como os diversos ajustes medicamentosos que fragilizam a transferência de cuidado para a atenção primária, aumentando o risco de Problemas Relacionados a Medicamentos (PRMs). O farmacêutico executa a prevenção, detecção e resolução das PRMs e influencia positivamente o pós-hospitalar através de suas intervenções, como a Reconciliação Medicamentosa (RM). O objetivo deste estudo foi identificar referenciais que demonstrem a importância do farmacêutico no momento da alta hospitalar e elaborar um Procedimento Operacional Padrão (POP) baseado nas evidências científicas a fim de orientar a conduta farmacêutica no contexto da alta hospitalar e produzir um material didático que contribua na orientação farmacêutica inserido em uma instituição hospitalar. Trata-se de uma revisão integrativa utilizando a estratégia PICO para pergunta norteadora, seguindo os seguintes descritores: “alta hospitalar”, “cuidado farmacêutico”, “reconciliação de medicamentos” e “segurança do paciente”. Os resultados encontrados nos artigos demonstram a importância do farmacêutico durante a alta hospitalar, diminuindo e evitando PRMs, reduzindo reinternações hospitalares e custo, proporcionando a segurança do paciente. Dessa forma, é importante que esse profissional seja incluído no processo de alta, melhorando o planejamento, diminuindo tempo de internação e garantindo o uso racional do medicamento.

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Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial

Cited by 4 publications

References 20 publications

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Improving inpatient discharge workflows through pharmacist pending discharge medication orders

Importância do farmacêutico na alta hospitalar qualificada: Revisão integrativa

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