The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before—After prospective study

Sara Daliri, Jacqueline G. Hugtenburg, Gerben ter Riet, Bart J. F. van den Bemt, Bianca M. Buurman, Wilma J. M. Scholte op Reimer, Marie-Christine van Buul-Gast, Fatma Karapinar-Çarkit

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Abstract

Background Medication-related problems are common after hospitalization, for example when changes in patients’ medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge. Methods A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient’s own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data. Results We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38–0.86, adjusted odds ratio 0.50; 95% CI 0.31–0.79). Conclusions A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
Original languageEnglish
Article numbere0213593
JournalPLoS ONE
Volume14
Issue number3
DOIs
Publication statusPublished - 1 Mar 2019

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Daliri, S., Hugtenburg, J. G., ter Riet, G., van den Bemt, B. J. F., Buurman, B. M., Scholte op Reimer, W. J. M., ... Karapinar-Çarkit, F. (2019). The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before—After prospective study. PLoS ONE, 14(3), [e0213593]. https://doi.org/10.1371/journal.pone.0213593