The medication review service was implemented in 68% of participating pilot Belgian community pharmacies but would require adapted resources and supports for larger scale implementation.
Background and objectives Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients. Methods Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders. Focus group discussions were audiotaped and observation files were constructed. For the analysis, a thematic framework approach was used. Between November 2015 and April 2016, 19 additional interviews and 1 focus group were performed with general practitioners (GP) and community pharmacists (CP). Results This qualitative study provided a long list of problems that could be summarised in five clusters: (1) problems at admission, e.g. incomplete list of medication, absence of information in case of emergency admission; (2) problems at discharge, e.g. lack of communication with GP, insufficient supplies of medication for the weekend; (3) problems as to professions, e.g. GP's opinion different to that of the medical specialist; (4) problems as to patients and family, e.g. failure to understand treatment; (5) problems as to processes, e.g. medication substitutions. Conclusion HCPs and patients experience many problems in medication management at transition between settings of care. The fact that these problems occur at different stages and persist over time stresses the necessity for multilevel solutions.
BackgroundAged polymedicated patients are particularly vulnerable for drug-related problems. A medication review aims to optimize the medication use of patients and improve health outcomes. In this study, the effect of a pharmacist-led medication use review is investigated for polymedicated ambulatory older patients with the aim of implementing this pharmaceutical care intervention across Belgium.MethodsThis article describes the study protocol of the SIMENON study and reports the results of the feasibility study, which aimed to test and optimize this study protocol. In the SIMENON intervention study, 75 Belgian community pharmacies each recruit 12 patients for a medication use review. For each patient, the identified drug-related problems and subsequent interventions are registered using the PharmDISC classification. In a subset of Dutch speaking patients, a pretest-posttest single group design is used to measure the impact of this review on patient related outcomes using questionnaires. The main outcome of the study is the type and number of drug-related problems and related interventions. A second outcome is the impact of the medication use review on adherence, objectively measured with dispensing data. Evolution in medication related quality of life is another outcome, measured with the Living with Medicines Questionnaire version 3. Other patient reported outcomes include adherence, self-management, patient satisfaction, fall incidents and use of emergency healthcare services.DiscussionThe findings of this study can provide data on the effectiveness of a medication use review in the Belgian primary care setting. Furthermore, it will provide insights in which patients benefit most of this intervention and therefore facilitate the implementation of medication review in Belgium.Trial registrationClinicalTrials.gov NCT03179722. Retrospectively registered 7 June 2017.
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