Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

Abstract

BackgroundThe resolution of potential drug-related problems is a priority of pharmaceutical care programmes.ObjectivesTo assess the clinical impact on drug-related negative outcomes of a pharmaceutical care programme focusing on the resolution of potential drug-related problems, initiated in the emergency department for patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD).MethodsControlled trials, in which older adults (≥65 years) receiving four or more medications admitted to the emergency department for ≥12 hours for worsening of HF and/or COPD were randomised (1:1) to either a pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department (intervention group (IG)) or standard care (control group). Comparisons between the groups were made for the proportion of patients with drug-related negative outcomes, number of drug-related negative outcomes per patient, mean stay, patients readmitted within 180 days and 180-day mortality.Results118 patients were included, 59 in each group. Fewer patients in the IG had drug-related negative outcomes (37 (62.7%) vs 47 (79.7%) in the control group (p=0.042)). Fewer drug-related negative outcomes per patient occurred in the IG (56 (0.95 per patient) vs 85 (1.44 per patient) in the control group (p=0.01)). The mean stay was similar between groups (194.7 hours in the IG vs 242.5 hours in the control group (p=0.186)). No difference in revisits within 180 days was found (32 (54.24%) in the IG vs 22 (37.3%) in the control group (p=0.065)). 180-Day mortality was detected in 11 (18.6%) patients in the IG compared with 13 (22%) in the control group (p=0.647).ConclusionA pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department has a favourable clinical impact, as it reduces the number and prevalence of drug-related negative outcomes. No difference was found in other outcome variables.Trial registration number NCT02368548.

Promoting clinical pharmacy services through advanced medication review in the emergency department

“…In 2017, a randomised clinical trial compared the impact of a pharmaceutical care programme initiated in the ED with that of standard care in 118 patients diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure 17. The impact was measured by the decrease in drug related negative outcomes.…”

Chronic Obstructive Pulmonary Disease Treatment and Pharmacist-Led Medication Management

“…106 Another pharmaceutical care programme initiated at the emergency department showed positive clinical benefits due to the reduced number and prevalence of drug-related negative outcomes. 103 In a pre-and post-intervention study over a period of 12 with better adherence was significantly increased from 37.4% to 53.2% through pharmacist-led pharmaceutical care. 104 Furthermore, it was demonstrated that individualized pharmaceutical care also improved inhalation technique, reduced readmissions and elevated health-related quality of life (HRQoL) in patients with COPD.…”

“…Emerging trials suggest that pharmaceutical care has a positive impact on treatment outcomes in COPD patients, especially in the treatment of AECOPD. [103][104][105] In a randomised, controlled, prospective clinical trial, the structured education on COPD and the management of its symptoms which were provided by clinical pharmacists, could significantly improve patients' COPD knowledge, medication adherence, medication beliefs, and hospitalization rates. 106 Another pharmaceutical care programme initiated at the emergency department showed positive clinical benefits due to the reduced number and prevalence of drug-related negative outcomes.…”

Cardiovascular co-morbidity in patients with COPD in Bulgaria

“…In this respect, a multidisciplinary approach which also includes the expertise of pharmacists in terms of preventing drug-related problems would be valuable to reduce the rate of ER visits or hospitalizations [36]. This is now more important than ever, especially in the current situation of global COVID-19 pandemic, because it is already proven that patients with COPD and cardiovascular diseases are put at increased COVID-associated mortality risk [37].…”