Pharmacy-supported interventions at transitions of care: an umbrella review

Lipovec, Nanca Cebron; Zerovnik, Spela; Kos, Mitja

doi:10.1007/s11096-019-00833-3

Cited by 11 publications

(6 citation statements)

References 30 publications

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“…Moreover, the proportion of patients with at least one clinically important medication error at hospital discharge was 6-fold lower in the intervention group (9.3%) than in the control group (61.9%; p < 0.001), and, after adjustment for other patient and hospitalization characteristics, patients in the intervention group benefited from a 20-fold reduction in the risk of a clinically important medication error (multiple logistic regression, Table 3 ). Our results are consistent with those of previous studies that have repeatedly shown that pharmacist-led interventions reduce medication discrepancies and medication errors at transitions of care and are among the ones showing the greatest impact ( Nickerson et al, 2005 ; Mueller et al, 2012 ; Ensing et al, 2015 ; Michaelsen et al, 2015 ; Cheema et al, 2018 ; Lipovec et al, 2019 ).…”

Section: Discussionsupporting

confidence: 93%

Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial

Jošt,

Kerec Kos,

Kos

et al. 2024

Front. Pharmacol.

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Transitions of care often lead to medication errors and unnecessary healthcare utilization. Medication reconciliation has been repeatedly shown to reduce this risk. However, the great majority of evidence is limited to the provision of medication reconciliation within clinical trials and countries with well-established clinical pharmacy. Thus, this pragmatic, prospective, controlled trial evaluated the effectiveness of routine pharmacist-led medication reconciliation compared to standard care on medication errors and unplanned healthcare utilization in adult general medical patients hospitalized in a teaching hospital in Slovenia. All patients hospitalized in a ward where medication reconciliation was integrated into routine clinical practice were included in the intervention group and received admission and discharge medication reconciliation, coupled with patient counselling. The control group consisted of randomly selected patients from the remaining medical wards. The primary study outcome was unplanned healthcare utilization within 30 days of discharge, and the secondary outcomes were clinically important medication errors at hospital discharge and serious unplanned healthcare utilization within 30 days of discharge. Overall, 414 patients (53.4% male, median 71 years) were included—225 in the intervention group and 189 in the control group. In the intervention group, the number of patients with clinically important medication errors at discharge was significantly lower (intervention vs control group: 9.3% vs 61.9%). Multiple logistic regression revealed that medication reconciliation reduced the likelihood of a clinically important medication error by 20-fold, while a higher number of medications on admission was associated with an increased likelihood. However, no significant differences were noted in any and serious unplanned healthcare utilization (intervention vs control group: 33.9% vs 27.8% and 20.3% vs 14.6%, respectively). The likelihood of serious healthcare utilization increased with the age of the patient, the number of medications on admission and being hospitalized for an acute medical condition. Our pragmatic trial confirmed that medication reconciliation, even when performed as part of routine clinical practice, led to a substantial reduction in the risk of clinically important medication errors at hospital discharge but not to a reduction in healthcare utilization. Medication reconciliation is a fundamental, albeit not sufficient, element to ensure patient safety after hospital discharge.Clinical Trial Registration:https://clinicaltrials.gov/search?id=NCT06207500, identifier NCT06207500

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Section: Discussionsupporting

confidence: 93%

Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial

Jošt,

Kerec Kos,

Kos

et al. 2024

Front. Pharmacol.

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“…The findings from the included articles showed that many different pharmacist interventions have been explored, for example medication reconciliation in healthcare transitions, medication review, patient counselling and follow-up. 29 – 46 The literature reviews showed positive effects on medication discrepancies, DRPs, potential adverse drug events and hospital revisits related to adverse drug events; 31 , 34 , 39 , 40 however, no single preferred, effective pharmacist-led intervention or a consensus for best practice has been identified. 40 …”

Section: Resultsmentioning

confidence: 99%

“…The findings from the included articles showed that many different pharmacist interventions have been explored, for example medication reconciliation in healthcare transitions, medication review, patient counselling and followup. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] The literature reviews showed positive effects on medication discrepancies, DRPs, potential adverse drug events and hospital revisits related to adverse drug events; 31,34,39,40 however, no single preferred, effective pharmacist-led intervention or a consensus for best practice has been identified. 40 Medication-related pharmacist interventions in GP were most effective when they were multifaceted and involved patient follow-up and interdisciplinary collaboration with face-to-face communication.…”

Section: Development Of the Intervention Synthesismentioning

confidence: 99%

“…-Medication-related pharmacist interventions to improve patient safety in, respectively, sector transitions and GP, may include elements like medication history 29,30 ; medication reconciliation [30][31][32][33][34][35][36][37][38] ; medication review 29,30,36,[38][39][40][41] ; and patient counselling/follow-up 29,30,36,38,39,41,42 -Interventions were most effective when they were multifaceted 34,39,41,43 and involved inter-professional collaboration 30,[38][39][40][41]44 with for example face-to-face communication 41 -There is no unambiguous conclusion on which interventions are most effective 30,36,39,43 -No two practices are alike; interventions need to be flexible 39 -Considering patient needs and involving patients may be important for implementing change 38,44,47 ii. What does the primary healthcare sector experience?…”

Section: What Does the Literature Say?mentioning

confidence: 99%

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Developing and piloting a cross-sectoral hospital pharmacist intervention for patients in transition between hospital and general practice

Sørensen

Jeffery

Falhof³

et al. 2023

Therapeutic Advances in Drug Safety

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Background: Healthcare is challenged by a rapidly growing group of patients with multi-morbidity and polypharmacy. Increasing activity and specialization puts pressure on healthcare sectors. Medication errors in cross-sectoral transition of patients are often seen. The aim of the study was to explore drug-related problems (DRPs) in the transition of patients between sectors and to develop and pilot-test a cross-sectoral hospital pharmacist intervention to overcome some of these problems. Methods: DRPs in cross-sectoral transitions were explored from four perspectives; the literature, the primary and secondary healthcare sector and the patients. An intervention was developed from the findings through co-creation between pharmacists, doctors and a nurse. The intervention was piloted and evaluated from data on the included patients and the activities performed. Results: DRPs in transitions from general practice (GP) to hospital were caused by inadequate focus on updating the Shared Medication Record (SMR). For patients being discharged, DRPs were described with multiple facets; for example, missing information on medication changes, lacking patient involvement and problems with dose-dispensed medicine or electronic prescriptions. An intervention with a pharmacist in a shared employment between Hospital Pharmacy and GP was developed and piloted. The intervention included medication reconciliation and updating SMR for patients referred to hospital; and medication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital. The intervention identified and solved several DRPs; in this way, medication errors were avoided. Access to health records in both sectors was important in the identification and resolution of DRPs. Conclusion: DRPs in cross-sectoral transitions are multifaceted and the experiences depend on the point of view. The cross-sectoral hospital pharmacist intervention identified and solved several DRPs and medication errors were avoided. The intervention made sense to both healthcare sectors and patients. Shared employment and unique access to health records in both sectors showed to be of importance in the identification and resolution of DRPs. Plain language summary Development and pilot-test of a pharmacist intervention for patients in transition between hospital and general practice Background: Healthcare is challenged by a rapidly growing group of patients with multiple chronic diseases treated with several drugs at the same time. The aim of the study was to explore drug-related problems in the transition of patients between the hospital and patients’ general practitioner and to develop and pilot-test a pharmacist intervention to overcome some of these problems. Methods: Drug-related problems in patient transitions were explored from the perspectives of the hospital, the general practitioner, the patients and the literature. An intervention was developed from the findings by pharmacists, doctors and a nurse. The intervention was pilot-tested and evaluated from the descriptions of the included patients and activities performed. Results: Drug-related problems in transitions from general practice to hospital were caused by inadequate focus on updating the Shared Medication Record. For patients being discharged, drug-related problems were related to for example missing information on medication changes sparse involvement of the patient in their own treatment problems with medicine dispensed on a dose dispensing machine at the local pharmacy. An intervention with a pharmacist in a shared employment between Hospital Pharmacy and general practice was developed and piloted. The intervention included talking to the patient about their medication and updating the Shared Medication Record for patients referred to hospital medication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital to general practice. The intervention identified and solved several drug-related problems. Access to health records in both the general practice and at the hospital was important in the identification of drug-related problems. Conclusions: Drug-related problems in cross-sectoral transitions are multifaceted. The pharmacist intervention identified and solved several drug-related problems. The intervention made sense to the general practitioner, hospital and patients. Shared employment and unique access to health records in both the general practice and at the hospital showed to be of importance in the identification of drug-related problems.

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“…Other reviews highlight the high heterogeneity between studies makes it difficult to assess the impact of a single clinical pharmacist activity on patient clinical outcomes, such as medication reconciliation, or medication review. 18 , 20 , 23 , 98 , 100 , 101 , 103 This is mainly due to the variability in use of different terms and lack of definition of these activities in the study methods.…”

Section: Discussionmentioning

confidence: 99%

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review

Costello

Barras

Foot

et al. 2023

Exploratory Research in Clinical and Social Pharmacy

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Pharmacy-supported interventions at transitions of care: an umbrella review

Cited by 11 publications

References 30 publications

Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial

Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial

Developing and piloting a cross-sectoral hospital pharmacist intervention for patients in transition between hospital and general practice

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review

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