Transfer of care – a randomised control trial investigating the effect of sending the details of patients’ discharge medication to their community pharmacist on discharge from hospital

Abstract

Sending a copy of patients' discharge letters to their community pharmacists could be beneficial in reducing post-discharge prescribing discrepancies and improving patient understanding of the changes made to their medicines.

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

“…In total, 14 studies reported data concerning the frequency of UMDs [49,50,57,59,60,66,70,74,83,84,88,93,95,98]. Three studies [83,84,93] used an established UMD definition, seven [49,50,59,60,70,74,95] developed their own and four [57,66,88,98] did not report any definition.…”

“…Table 4 summarises outcome rates of the included studies per patient population. [72], three ADR studies [62,64,91], nine ADE studies [24, 54-56, 61, 69, 78, 80, 94] and five UMD studies [59,66,70,88,95]. Seven studies [54,61,62,64,72,78,80] reported severity assessment based on existing rating scales published in the literature.…”

“…Among patients affected by UMDs, three studies reported that between 25 and 34% of elderly patients [66,88], and 63.3% of paediatric patients were affected by moderate harm events [95]. Two studies reported that 33-38% of UMDs identified post-hospital discharge as associated with a high potential of harm in adult patients [59,70]. Appendix 9 of the ESM includes a summary of severity data of the included studies.…”

The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis

“…Sixteen (44%) had greater levels of involvement that included activities such as home visits, medication therapy management sessions, comprehensive medication reviews, motivational interviewing, identification and resolution of drug therapy problems, and patient education. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Twenty-three studies were randomized trials, [19][20][21][22][23][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44][54][55][56] with the remaining 13 studies consisting of various nonrandomized designs. 18,24,25,35,[45][46]…”

A community pharmacist–led service to facilitate care transitions and reduce hospital readmissions

“…A small number of studies have explored how community pharmacists can participate in medication management for patients moving from the hospital to home. Interventions have included contacting community pharmacists to update them on medication changes, [19][20][21] on-site outpatient pharmacists meeting with patients to provide initial fills of new medications and counseling, 22 home visits, 23 and telephone follow-ups. 22,24 Pharmacists working in community settings have positive attitudes about their impact on care transitions but have identified barriers such as limited time and difficulty getting the necessary patient data needed to understand the patient's postdischarge medication orders.…”