Abstract
BackgroundMedication errors at transition of care can adversely affect patient safety. The objective of this study is to determine the effect of a transitional pharmaceutical care program on unplanned rehospitalisations.MethodsAn interrupted-time-series study was performed, including patients from the Internal Medicine department using at least one prescription drug. The program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within six months post-discharge. Secondary outcomes were drug-related hospital visits, drug-related problems (DRPs), adherence, believes about medication, and patient satisfaction. Interrupted time series analysis was used for the primary outcome and descriptive statistics were performed for the secondary outcomes.ResultsIn total 706 patients were included. At 6 months, the change in trend for unplanned rehospitalisations between usual care and the program group was non-significant (− 0.2, 95% CI -4.9;4.6). There was no significant difference for drug-related visits although visits due to medication reconciliation problems occurred less often (4 usual care versus 1 intervention). Interventions to prevent DRPs were present for all patients in the intervention group (mean: 10 interventions/patient). No effect was seen on adherence and beliefs about medication. Patients were significantly more satisfied with discharge counselling (68.9% usual care vs 87.1% program).ConclusionsThe transitional pharmaceutical care program showed no effect on unplanned rehospitalisations. This lack of effect is probably because the reason for rehospitalisations are multifactorial while the transitional care program focused on medication. There were less hospital visits due to medication reconciliation problems, but further large scale studies are needed due to the small number of drug-related visits. (Dutch trial register: NTR1519).
Highlights
Medication errors at transition of care can adversely affect patient safety
Karapinar-Carkit F, et al Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital
We regarded a randomized design as not feasible, because we changed how care was organised and previous experiences with pilot projects have shown that the Continuity Of Appropriate pharmacotherapy (COACH) program contaminates usual care as residents and other healthcare providers learn from the COACH program
Summary
Medication errors at transition of care can adversely affect patient safety. Medication errors occur frequently at transition of care and can negatively affect patient safety [1]. In combination with patients’ recall bias this results in incorrect prescriptions at hospital admission [2]. These admission errors can carry over to the discharge medication. Discharge letters and prescriptions generally do not contain the entire pharmacotherapy and changes therein [5, 6] Both the general practitioner and community pharmacy lack information of reasons for all changes, making it unclear whether changes should be maintained, were only temporary or were unknown to hospital staff [7, 8]
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