Polypharmacy
Conditions
Keywords
transition of care, pharmacists, hospital discharge, collaboration
Brief summary
The aim of this study is to evaluate the impact of an enhanced collaboration between a hospital pharmacist and a community pharmacist during hospital discharge. For patients taking multiple medications, hospitalization often involves numerous changes to their treatment regimen. For community pharmacies, discharge prescriptions are often complex, and they sometimes lack the information that pharmacists need to deliver the treatment as safely as possible. As a result, there is a risk of medication errors, and a risk for patients. We aim to evaluate the benefits of this collaboration for adult patients admitted to the internal medicine ward of a regional hospital who are taking seven or more drugs and are being discharged to home. The main question it aims to answer is : Does the enhanced collaboration reduce the number of drug-related problems encountered by community pharmacists with discharge prescriptions ? Researchers will compare patients when a hospital pharmacist is involved during the discharge process and when he or she is not involved, which corresponds to normal care. The hospital pharmacist will not perform the intervention directly on the patient, but only with the community pharmacy. Once they agree to participate in the study, patients will only have to go to their usual community pharmacy after discharge and accept that the hospital transmits medical information to their usual pharmacy.
Interventions
OTHERSupport of the hospital pharmacist for the medication management at hospital discharge
1\) The hospital pharmacist calls the community pharmacy the day before discharge to order unusual or specific medications 2) The day of discharge, the hospital pharmacist performs a medication reconciliation in collaboration with the hospital physician 3) Once completed, the discharge prescription is sent to the community pharmacy before the patient is discharged. 4) The hospital pharmacist calls the community pharmacy to provide additional information about the patient and the prescription and to answer any questions. Additional information will help the community pharmacist to understand the prescription : administrative data, clinical data, medication-related information, patient follow-up and patient concerns.
Sponsors
Pharmacie des Hopitaux de l'Est Lemanique
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients admitted to the internal medicine ward for more than 48 hours * Patients prescribed seven or more drugs at the time of screening * Patients discharged to home * Patients able to give informed consent as documented by signature
Exclusion criteria
* Patient discharged to another hospital, nursing home or rehabilitation clinic * Refusal of the community pharmacy to participate * Inability to sign consent and follow the procedures of the study, due to language problems, psychological disorders, dementia, alterations of consciousness and lack of judgement
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of drug-related problems on the hospital discharge prescription | 7 days after hospital discharge | Community pharmacists will assess the number of drug-related problems (DRP) on the discharge that they faced when preparing the discharge medication. They will have to use the PharmDISC system, which is a validated tool for referencing drug-related problems faced in the community which was adapted from the drug-related problems classification system of the Pharmaceutical Care Network Europe (PCNE). Community pharmacists will also document the intervention performed for each DRP, and the resolution (yes/no) of the DRP. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient's satisfaction | 7 days after hospital discharge | Patients' satisfaction related to their visit at the pharmacy after hospital discharge will be assessed using a questionnaire. Patients will be contacted via email or telephone |
| Community pharmacists' satisfaction | Through study completion, approximately 6 months | The satisfaction of community pharmacists with the service provided by the hospital pharmacist at patient discharge will be evaluated |
| 30 day readmission rate | 30 days after hospital discharge | Number of participants with hospital emergency department visits and hospital readmission in the same hospital within 30 days of discharge |
Countries
Switzerland
Contacts
STUDY_DIRECTORAnne-Laure Blanc, PharmD, PhD
Pharmacie des Hôpitaux de l'Est Lémanique
Outcome results
None listed