Integrated Medicines Management Research Articles

Effect of integrated medicines management on quality of discharge medication information - a secondary endpoint in a randomized controlled trial.

High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information. Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information. The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 (mean difference 2.7, 95% CI 2.3-3.2, p < 0.001). In total 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), p < 0.001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6-4.4, p < 0.001). Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.

The Medicines Optimisation Innovation Centre: a dedicated centre driving innovation in medicines optimisation-impact and sustainability

BackgroundSub-optimal medicines use is a challenge globally, contributing to poorer health outcomes, inefficiencies and waste. The Medicines Optimisation Innovation Centre (MOIC) was established in Northern Ireland by the Department of Health (DH) in 2015 to support implementation of the Medicines Optimisation Quality Framework.AimTo demonstrate how MOIC informs policy and provides support to commissioners to improve population health and wellbeing.SettingMOIC is a regional centre with multidisciplinary and multi-sector clinical expertise across Health and Social Care and patient representation.DevelopmentCore funded by DH, MOIC has a robust governance structure and oversight programme board. An annual business plan is agreed with DH. Rigorous processes have been developed for project adoption and working collaboratively with industry.ImplementationMOIC has established partnerships with academia, industry, healthcare and representative organisations across Europe, participating in research and development projects and testing integrated technology solutions. A hosting programme has been established and evaluation and dissemination strategies have been developed.EvaluationMOIC has established numerous agreements, partnered in three large EU projects and strengthened networks globally with extensive publications and conference presentations. Informing pathway redesign, sustainability and COVID response, MOIC has also assisted in the development of clinical pharmacy services and antimicrobial stewardship in Europe and Africa. Northern Ireland has been recognised as a 4-star European Active and Healthy Ageing Reference Site and the Integrated Medicines Management model as an example of best practice in Central and Eastern Europe.ConclusionMOIC has demonstrated considerable success and sustainability and is applicable to health systems globally.

Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist-led interdisciplinary intervention to improve medication safety in older hospitalized patients.

The majority of hospitalized older patients experience medication-related problems (MRPs), and there is a call for interventions to solve MRPs and improve clinical outcomes like medical visits. The IMMENSE study is a randomized controlled trial investigating the impact of a pharmacist-led interdisciplinary intervention on emergency medical visits. Its multistep intervention is based on the integrated medicines management methodology and includes a follow-up step with primary care. This study aims to describe how the intervention in the IMMENSE study was delivered and its process outcomes. The study includes the 221 intervention patients in the per-protocol group of the IMMENSE study. Both intervention delivery, reasons for not performing interventions and process outcomes were registered daily by the study pharmacists in a Microsoft Access® database. Process outcomes were medication discrepancies, MRPs and how the team solved these. A total of 121 (54.8%) patients received all intervention steps if appropriate. All patients received medication reconciliation (MedRec) and medication Review (MedRev) (step 1 and 2), while between 10% and 20% of patients were missed for medication list in discharge summary (step 3), patient counselling (step 4), or communication with general practitioner and nurse (step 5). A total of 437 discrepancies were identified in 159 (71.9%) patients during MedRec, and 1042MRPs were identified in 209 (94.6%) patients during MedRev. Of these, 292 (66.8%) and 700 (67.2%), respectively, were communicated to and solved by the interdisciplinary team during the hospital stay. The fidelity of the single steps of the intervention was high even though only about half of the patients received all intervention steps. The impact of the intervention may be influenced by not implementing all steps in all patients, but the many discrepancies and MRPs identified and solved for the patients could explain a potential effect of the IMMENSE study.

Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial

ObjectiveTo investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival.DesignParallel-group, randomised controlled trial.SettingRecruitment from an internal medicine hospital ward in Oslo, Norway....

Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems

BackgroundThe Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from...

Ensuring continuity of patient care across the healthcare interface: Telephone follow‐up post‐hospitalization

To implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group. Pragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service. Using an intention to treat approach, reductions in 30- and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio =0.57; 95% confidence interval (CI): 0.36-0.90; P<0.001] and 15.2% (odds ratio=0.53; 95% CI: 0.36-0.79; P=0.021) respectively. Marginal mean time to readmission was 70.9days (95% CI: 66.9-74.9) for intervention group compared with 60.1days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3days vs. 6.7days; P<0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to -2.27; P<0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P<0.001). Most patients (83.8%) reported having better control of their medicines after the intervention. Pharmacist-led postdischarge structured TFU intervention can reduce 30- and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction.

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial

IntroductionDrug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise...

The Impact of a Pharmacist Independent Prescriber on the Discharge Processes at the Weekend in an Acute Hospital

Introduction: Clinical Pharmacists within the Northern Health and Social Care Trust are responsible for completing the medication section of the discharge letter on weekdays. This releases medical doctor time to complete other tasks. This is in place in all medical wards in Antrim Area Hospital during weekdays and was shown by to decrease the time taken for completion of the discharge process 1. In addition, the process results in a more accurate discharge prescription, therefore reducing the risk of errors2. Walker et al.investigated having a pharmacist involved in the entire discharge process and found that on discharge the control group (no pharmacist input) had 218 discrepancies on discharge prescriptions compared to 120 discrepancies in the group that had pharmacist intervention.2 Short Description:The introduction of a pharmacist prescriber to complete the medication section of the discharge was time neutral compared to the medical doctor at the weekend but freed up the time for the medical doctor to review other sick patients. It also reduced the number of errors leading to a more accurate discharge letter. Aim and Theory of Change: Delays in discharge at weekends are often due to the lack of availability of medical staff to complete the discharge letters. The introduction of a pharmacist prescriber to complete the medication sections released medical staff and allowed the medications to be prepared in anticipation of the clinical narrative section of the discharge letter. If the clinical narrative was pre-prepared it removed the need for medical staff for discharge and increased time to discharge. Targeted Population and Stakeholders: All patients who were over 18 and inpatients in medical wards at Antrim Area Hospital were included. Stakeholders included: patients, pharmacy staff, junior medical staff and ward nursing staff. Timeline: This work was completed between October 2015 and December 2015 Highlights: The time for a medical doctor to prepare the medications on a discharge letter and a clinical pharmacist to review it was the same as the time for the pharmacist prescriber to prepare the medications on the letter, thereby maximising use of skill mix. Comments on sustainability: There was no increase in pharmacist numbers at the weekend. Just a change in working pattern so no additional resource needed. Comments on transferability: This could be transferred to any hospital with clinical pharmacists who have completed their independent prescribing course and is competent in the required areas. Conclusions: Overall the time taken to complete a discharge when written by a prescribing pharmacist compared to a clinical check by a pharmacist is the same. The benefit is the release of medical staff time to review other patients. Discussions: The overall time to complete a discharge prescription from start to finish when a medical doctor has prepared the discharge letter including medications was 38 minutes. The time to complete the discharge medications when a prescribing pharmacist has written the medication section of the letter was 42 minutes. This was evaluated and found not to be statistically significant. (p= 0.269) The time difference was the exact time that was previously found to be saved on medical staff time by having a prescribing pharmacist complete the medication section Lessons learned: Only medical patients were audited. There is a need to audit in other populations for example cardiology and surgery

Polypharmacy and Adherence: Key Components of Integrated Care. The case of Northern Ireland

Introduction: Polypharmacy and medication adherence in the older population are significant public health issues throughout the European Union (EU), and are critical issues in integrated care. SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) is a consortium of 10 organizations representing 8 EU countries with the goal of stimulating innovation around polypharmacy and adherence, ultimately providing the tools for EU policy makers to adopt new programs addressing this issue into existing healthcare systems. Methods: A mixed-methods case study is ongoing in Northern Ireland to characterise the polypharmacy and adherence programme within the region. A desk review of the polypharmacy and adherence policies at the government, regional and institutional level has been completed. The policies and practices of the Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland and two National Health Service (NHS) Trusts were included for analysis. Key informant interviews will be conducted with policymakers, managers, and clinicians responsible for developing and implementing this system to highlight the change management strategies employed to implement this programme. Focus groups will then be used to validate the research findings. Final analysis will be completed in April 2016. Preliminary results: Based on the desk review, Northern Ireland has an advanced polypharmacy and adherence programme targeted at patients with multiple chronic conditions and older adults at risk for adverse drug events. In 2013, NI was recognised as a Reference Site and was awarded 3-stars for its medicines management systems which have a particular focus on older people. Key to this award was the contribution towards management of long term conditions, via the development of the integrated medicines management service and the development of enabling technological solutions. Success in this work depends upon collaboration between key pharmacy stakeholders within Northern Ireland, other staff & departments within Health & Social Care, and those based at the Universities. In addition, a number of key commercial partnerships have been developed. Full results including key informant interview and focus groups will be presented. Conclusion and future work: Results from key informants will further elucidate how the programme was developed and implemented, providing insight into strategies other health care systems may employ to implement a similar programme. These results combined with the other SIMPATHY case studies will provide valuable tools for policymakers, researchers, and clinicians throughout Europe as they move to integrate polypharmacy and adherence programmes into existing health care systems. Funding: This poster is part of the SIMPATHY project (663082) which has received funding from the European Union’s Health Programme (2014-2020).

Impact of an integrated medicines management service on preventable medicines-related readmission to hospital: a descriptive study

BackgroundMedication contributes to 5–20% of hospital admissions, of which half are considered preventable. An integrated medicines management service (IMMS) was developed at a large general hospital in London to identify...

Integrated medicines management service may reduce hospital readmissions

Integrated medicines management service may reduce hospital readmissions

Integrated medicines management to medicines optimisation in Northern Ireland (2000–2014): a review

ObjectiveThe objective of this review was to assess the improvement in medicines processes in Northern Ireland focusing mainly on secondary care and at the interface with primary care and also...

Pharmacist assessment of drug-related problems on an oncology ward

ObjectivesCancer patients have a high incidence of concurrent chronic diseases, the pharmacological treatment of which is generally complex and carries an inherent risk of drug-related problems (DRPs). DRPs can interfere...

Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms.

This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized.

Evaluation of implementation of clinical pharmacy services in Central Norway

This paper describes the implementation of a clinical pharmacy services in hospitals in Central Norway. Our model for clinical pharmacy services is based on the Integrated Medicines Management (IMM) model...

Results from a project to develop systematic patient focused clinical pharmacy services. The Lund Integrated Medicines Management model

As people get older, polypharmacy increases and there is an increased risk of adverse drug events, drug interactions, low medication adherence, increasing economic burden, hospital admissions and even drug-related deaths.1...

GRP-040 Clinical Significance of Recommendations Made by Pharmacists About Drug-Related Problems (DRP)

BackgroundThe Ministry of Health in Norway has requested an expanded contribution from clinical pharmacy in healthcare delivery because of serious medication-related issues. Examples of this are participation in treatment teams...

GRP-006 A Policy Review of the Application of the Integrated Medicines Management Service Model in Northern Ireland

BackgroundSince 2002, the Integrated Medicines Management Service (IMM) has strategically re-engineered clinical pharmacy services in the five acute Health and Social Care Trusts (HSCTs) in Northern Ireland. The Department of...

CPC-051 Evaluation of Implementation of Clinical Pharmacy Services in Central Norway

BackgroundCentral Norway Pharmaceutical Trust consists of six hospital pharmacies covering eight hospitals. In partnership with a research group at the University of Lund and the Lund Hospital Pharmacy, Sweden, we...

CPC-114 Prevalence and Management of Drug-Related Problems in an Intensive Care Unit

BackgroundPatients admitted to intensive care units (ICUs) are at higher risk than other patients of having problems, injuries and adverse drug reactions (ADRs) associated with their drug treatment.Purpose To identify...