Objective Medically complex patients experience fragmented health care compounded by long wait times. The MedREACH program was developed to improve access and overall system experience for medically complex patients. Program description MedREACH is a novel primary-tertiary care collaborative demonstration program that features community nursing outreach, community specialist outreach, and a multi-specialty consultation clinic. Methods All 179 patients, referring primary care clinicians, and specialists involved were eligible to participate. Patient and clinician feedback were elicited by feedback surveys. Process measures were evaluated by participant retrospective chart reviews. Community nursing outreach patients completed the Goal Attainment Scale. Results Forty-eight patients and 22 clinicians consented to the feedback survey. About 75% of patients were seen within 2 weeks of referral. Patients spent an average of 3, 1.63, and 1.2 visits with the nursing outreach, multi-specialty clinic, and specialist outreach, respectively. Patients indicated a better medical experience, health enablement, and goals attainment. Family physicians felt more supported in the community management of medically complex patients and, overall, physicians felt MedREACH could improve collaborative care for medically complex patients. Qualitative analysis of clinician responses identified the need for increased mental health services. Discussion MedREACH demonstrates a patient-centered link between primary and tertiary care that could improve health care access and overall experience.
Bright et al.: Drug Information QueriesDrug information centers have been established to provide unbiased information to healthcare workers and patients. The pattern of drug information queries received and answered by the drug information centre in a tertiary care teaching hospital in South India was assessed. Prospectively documented drug information queries, received and answered by the drug information centre over a 15-month period, were reviewed retrospectively for various parameters including status of the requestor, mode of receipt, mode of reply, type of query, purpose of query and references used. A total of 2010 queries were received and answered during the study period. Queries were received mainly from physicians (41 %), followed by nurses (n=595; 30 %) and pharmacists (n=462; 23 %). Dentists, students and healthcare professionals from outside the institution accounted for 139 (6 %) queries. Internet-based resource was the main reference source (n=952; 47 %) followed by textbooks, intranet resources and journals. Patient care-related queries were the most common. The information sought included product identification (22 %), drug dose or schedule (16 %), product availability (13 %), drug of choice/therapeutic alternatives/therapeutic use (10 %), product information (10 %), drug use in special populations and administration (6 % each), compatibility/stability/storage (5 %) and adverse reactions (4 %). The drug information centre in a teaching hospital handles a wide range of queries from various healthcare workers, meets specific healthcare needs and serves as a valuable source of drug information. The impact of this service on improving patient care and minimizing errors warrants further study.
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