Development of a collaborative transitions-of-care program for heart failure patients

Abstract

The implementation of a pharmacy-led transitions-of-care program improved patient care by prioritizing those who needed medication reconciliation and led to increases in HF core measure compliance and patient satisfaction scores.

Transição Do Cuidado Do Hospital Para O Domicílio: Revisão Integrativa

“…O Quadro 1 apresenta os artigos, conforme autores, ano de publicação, objetivo e atividades desenvolvidas. (14) Descrever o desenvolvimento e a implementação de um programa de transição do cuidado com foco na reconciliação medicamentosa para pacientes com insuficiência cardíaca.…”

“…Os enfermeiros realizam educação em saúde sob diversos aspectos: mudança na dieta e possíveis restrições de alimentos (27)(28)33,35) , realização de exercícios físicos (25,35) , uso correto das medicações, como dosagem, frequência de administração e horários (14,(17)(18)(19)(21)(22)(25)(26)(28)(29)(30)33) , interações dos medicamentos de uso contínuo (14,16,20,26,32,35) , reconhecimento de sinais e sintomas da doença em curso (19)(20)(22)(23)(25)(26)(27)(28)30,35) e autocuidado no domicílio (15,22,35) . Alguns enfermeiros realizam a reconciliação medicamentosa, avaliando medicamentos de uso anterior à internação com os prescritos no ambiente hospitalar (16,20,24) .…”

Pharmacists get to the heart of the matter

“…Several recent studies on pharmacist services have focused on the prevention of readmissions of patients who were discharged from the hospital with targeted conditions, such as congestive heart failure. [13][14][15] Many of these transitional care models use pharmacists employed by the hospital, whereas other models may use community pharmacists. For example, Dempsey et al 13 describe the success of a transition-of-care pharmacist model for patients with a high risk of CVD and with hospitalization experience.…”

“…Over a 2-year follow-up period, patients who received care from a pharmacist had a reduction in hemoglobin A1c of 2.7% compared with that of 1.1% in patients who received standard care. 14 In addition to hypertension, hyperlipidemia, diabetes, and smoking cessation, a modifiable risk factor of cardiometabolic disease where pharmacists can intervene is the lack of physical activity. 15 An often overlooked area in the care of cardiometabolic patients is diet and lifestyle interventions because it is challenging for prescribers to address these in a meaningful manner during medical visits with a limited time period for multiple health care needs.…”

Rehabilitation and Discharge

“…Early hospital discharge may not lead to overall cost-savings if it results in the need for more intense subsequent health-care utilisation, such as ED visits or rehospitalisation. Hospital readmissions are often the result of a fragmented health and social care system [11] and increasing evidence indicates that patients are particularly vulnerable and more likely to experience negative outcomes during these hospital readmissions [12].…”