A developmental evaluation of an intraprofessional Pharmacy Communication Partnership (PROMPT) to improve transitions in care from hospital to community: A mixed-methods study

Abstract

Background: People transitioning from hospital-to community-based care are at increased risk of experiencing medication problems that can lead to adverse drug events and poor health outcomes. Community pharmacists provide medication expertise and support during care transitions yet are not routinely included in communications between hospitals and other primary health care providers. The PhaRmacy COMmunication ParTnership (PROMPT) intervention facilitates medication management by optimizing information sharing between pharmacists across care settings. This developmental evaluation sought to assess the feasibility and acceptability of implementing the PROMPT intervention, and to explore how contextual factors influenced its implementation. Methods: PROMPT was implemented for 14 weeks (January-April, 2018) in the general internal medicine units at two teaching hospitals in Toronto, Canada. PROMPT featured two contact points between hospital and community pharmacists around patient discharge: (1) faxing an enhanced discharge prescription and discharge summary to a patient's community pharmacy and (2) a follow-up phone call from the hospital pharmacist to the community pharmacist. Our mixed-method evaluation involved electronic patient records, process measures using tracking forms, telephone surveys and semi-structured interviews with participating community and hospital pharmacists. Results: The intervention involved 45 patients with communication between 12 hospital and 45 community pharmacists. Overall, the intervention had challenges with feasibility. Issues with fidelity included challenges with the medical discharge summary being available at the time of faxing and hospital pharmacists' difficulties with incorporating novel elements of the program into their existing practices. However, both community and hospital pharmacists recognized the potential benefits to patient care that PROMPT offered, and both groups proposed recommendations for further improvements. Suggestions included enhancing hospital staffing and resources.

Interprofessional and Intraprofessional Communication about Older People’s Medications across Transitions of Care

“…This was surprising, as doctors and nurses acknowledged and valued the role of pharmacists to manage medications at admission and discharge; yet, the processes for updating pharmacists about changing plans at these transition points were unreliable. Our findings support earlier work, which found that patients were sometimes transferred without pharmacists’ knowledge [ 12 ], and a lack of intraprofessional pharmacist handover between ward transfers was also seen in a study examining patient transfers between emergency departments and medical wards [ 19 ]. Another study similarly reported missed opportunities of interprofessional collaboration to enhance medication safety and frequent impromptu interactions [ 36 ].…”

“…Recent research examining medication management across transitions of care has focused on medication incidents [ 3 , 8 ], pharmacist-led interventions [ 9 , 10 , 11 , 12 ] and patient and family perspectives [ 13 , 14 ]. Research also identifies communication breakdowns contributing to medication incidents across transitions [ 15 , 16 ]; yet, little is known about what influences how health professionals communicate with each other to manage medications and avoid potential breakdowns in communication across transitions.…”

“…Research also identifies communication breakdowns contributing to medication incidents across transitions [ 15 , 16 ]; yet, little is known about what influences how health professionals communicate with each other to manage medications and avoid potential breakdowns in communication across transitions. Interview and focus group studies have investigated the perspectives of nurses, doctors and pharmacists [ 17 ] and communication between health professional disciplines [ 12 , 16 , 18 ]. Previous studies using observations that considered medication communication between health professionals were conducted within a single setting and examined general populations rather than focusing on older people [ 19 , 20 , 21 ].…”

Implementation of a pharmacist‐led transitional pharmaceutical care programme: Process evaluation of Medication Actions to Reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH)

“…Understanding how the MARCH programme was delivered and determining critical moderating factors clarifies whether the non‐significant effect of the programme was due to poor implementation or due to ineffectiveness of the programme as such and is necessary to implement and improve transitional care programmes. Several complex pharmacy‐led transitional care studies have been conducted 13–16,26–31 . However, only a few have evaluated its implementation fidelity 30,31 .…”

Clinical and Organizational Impacts of Medical Ordering Settings on Patient Pathway and Community Pharmacy Dispensing Process: The Prospective ORDHOSPIVILLE Study

“…Moreover, recognition of the corresponding pharmacist by the hospital could allow the pharmacist to send all correspondence such as hospital consultation letters or hospital discharge letters, as was already claimed [ 26 ]. Some countries such as Ohio (United States of America), Canada, and United Kingdom have already implemented programs to enhance the transition in care with positive results on patients [ 27 ] and less hospital readmissions, respectively [ 28 , 29 ]. For a few months in the United Kingdom, a program named Transfers of Care Around Medicines (TCAM) uses an online platform to transfer the discharge information to the community pharmacy chosen by the patient, which can contact him for a follow-up [ 30 ].…”