A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management

Abstract

Background Drug-related problems (DRPs) endanger geriatric patients' safety. Especially a follow-up treatment with increased number of care transitions is a critical time for patients. Objective This study aimed at optimising medication therapy and the transfer of medication-related information to ambulatory care in geriatric rehabilitation patients. Setting German geriatric rehabilitation centre (GRC). Method A prospective, controlled intervention study was performed. Patients in the control group (CG) received standard care, those in the intervention group (IG) an additional dual pharmaceutical intervention: (i) medication review to optimise in-hospital medication and (ii) improvement of discharge letters for optimising transfer of medication-related information. Main outcome measure (i) Number of patients with at least one DRP at discharge and (ii) predefined quality criteria for the discharge letters. Results 150 patients were enrolled in CG and 163 in IG. (i) At discharge, 126 (84%) patients in the CG were affected by at least one DRP. In the IG, the number of affected patients decreased to 64 (39%, P < 0.05). (ii) In comparison to discharge letters in the CG, predefined quality criteria were improved in the IG. Following differences were measured (CG vs. IG, each P < 0.05): active ingredient indicated (60 vs. 99%), brand name indicated (60 vs. 96%), explanation of medication changes (47 vs. 68%), visualisation of explanations next to the discharge medication (26 vs. 91%) and recommended therapy duration for short-term medications (49 vs. 84%). Conclusion DRPs and incomplete discharge letters affected many patients. The dual intervention improved in-hospital medication therapy and optimised the transfer of medication-related information.

Drug-Related Problems of Patients in Primary Health Care Institutions: A Systematic Review

“…The results of this research showed that the median (IQR) for the rates of accepted interventions was 78.8% (22.3%), the median (IQR) for the rates of implemented interventions was 64.15% (16.85%), and the median (IQR) for the rates of solved DRPs was 76.99% (26.09%), suggesting the intervention ability of DRPs and also reflecting the important role of pharmacists in DRPs intervention. The interventions of DRPs have been conducted in a number of studies, and serious consequences of DRPs have been avoided through pharmacists' intervention ( Freyer et al, 2018 ; Ylä-Rautio et al, 2020 ).…”

Detection and resolution of drug-related problems at hospital discharge focusing on information availability – a retrospective analysis

“…For many cases, additional clinical and/or patient-specific information is needed. The access to patientspecific information collected during a patient interview helps to detect adherence issues, medication use problems, knowledge gaps, and adverse drug reactions [18]. Since patients are often present when prescriptions are filled, they might be a reasonable source of information for the identification of DRPs after hospital discharge in the community pharmacy.…”

“…Since patients are often present when prescriptions are filled, they might be a reasonable source of information for the identification of DRPs after hospital discharge in the community pharmacy. Conversely, for the detection of, for example, incorrect dosing according to organ dysfunction, a medication without documented indication, or a diagnosis without treatment, pharmacists need access to clinical patient information [18]. However, in some European countries and in most community pharmacies in Switzerland, clinical patient information is not routinely accessible by pharmacists [20][21][22].…”

“…Pharmacist-led medication reconciliation leads to a significantly reduced number of ADE-related hospital readmissions and emergency department visits [15]. Conducting medication reviews at transitions within or between different healthcare settings showed positive effects on the number of DRPs [16,17]. Based on available information sources, PCNE defined simple, intermediate and advanced medication reviews (Table 1).…”

“…Based on available information sources, PCNE defined simple, intermediate and advanced medication reviews (Table 1). The detection of DRPs is directly linked to the types and sources of information available for medication reviews [18,19]. Nonetheless, studies indicate that community pharmacies in several European countries do not have routine access to clinical patient information [20][21][22].…”