Effectiveness of a medication discharge plan for transitions of care from hospital to outpatient settings

Lalonde, Lyne; Lampron, Anne-Marie; Vanier, Marie-Claude; Levasseur, Patrick A.; Khaddag, Rima; Chaar, Nesrine

doi:10.2146/ajhp070565

Cited by 36 publications

(22 citation statements)

References 19 publications

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“…Prior studies have reported each outcome individually: 64-79% of patients reported the correct indication, 40,41 56% the correct dosage, 40 and 68% the correct frequency. 40 The frequency of errors in our sample was similar to prior studies 18,19,42,43 but much higher than that the 14% observed by Coleman et al 17 In their study, medication errors were assessed by a geriatric nurse practitioner (GNP) during in-home interviews of recently discharged older adults. This method may have allowed the GNP to synthesize multiple sources of information in determining the patient's correct medications.…”

Section: Commentssupporting

confidence: 87%

Characteristics Associated With Postdischarge Medication Errors

Mixon

Myers

Leak

et al. 2014

Mayo Clinic Proceedings

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Objective To examine the association of patient- and medication-related factors with post-discharge medication errors. Patients and Methods The Vanderbilt Inpatient Cohort Study (VICS) includes adults hospitalized with acute coronary syndromes (ACS) and/or acute decompensated heart failure (ADHF). We measured health literacy, subjective numeracy, marital status, cognition, social support, education, income, depression, global health status, and medication adherence in patients enrolled between October 2011 and August 2012. We used binomial logistic regression to determine predictors of discordance between the discharge medication list and patient-reported list during post-discharge medication review. Results Among 471 patients, mean age was 59 years; mean total number of medications reported was 12; and 17% had inadequate or marginal health literacy. Half (51%) of patients had ≥1 one discordant medication (i.e., appeared either on the discharge or patient-reported list but not both); 27% failed to report a medication on their discharge list; and 36% reported a medication not on their discharge list. Additionally, 59% had a misunderstanding in indication, dose, or frequency in a cardiac medication. In multivariable analyses, higher subjective numeracy (Odds Ratio (OR)=0.81, 95% Confidence Interval (CI) 0.67-0.98) was associated with lower odds of having discordant medications. For cardiac medications, participants with higher health literacy (OR=0.84, CI 0.74-0.95), higher subjective numeracy (OR=0.77, CI 0.63-0.95), and who were female (OR=0.60, CI 0.46-0.78) had lower odds of misunderstandings in indication, dose, or frequency. Conclusion Medication errors are present in approximately half of patients following hospital discharge and are more common among patients with lower numeracy or health literacy.

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Section: Commentssupporting

confidence: 87%

Characteristics Associated With Postdischarge Medication Errors

Mixon

Myers

Leak

et al. 2014

Mayo Clinic Proceedings

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“…2,3,6 Medication discrepancies cause discharge-related adverse drug events, which occur in 12% to 17% of patients, and the incidence increases when 8 or more medications are prescribed. 1,3,4,[7][8][9] The risk of having an adverse drug event is greatest during the first 7 to 10 days after discharge, which is a particular concern for primary care providers (PCPs) who may not be able to offer patients appointments within this time frame. 10 A pharmacy intervention immediately after discharge may address this concern.…”

Section: Introductionmentioning

confidence: 99%

Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions

Hawes

Maxwell

White

et al. 2013

J Prim Care Community Health

156

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Purpose: Medication errors related to hospital discharge result in rehospitalization and emergency department (ED) visits, yet no systematic approach has been implemented nationally to decrease these medication errors. Pharmacist involvement during postdischarge transitions of care may be an important strategy to prevent and correct medication discrepancies and reduce costly rehospitalization and ED visits. Methods: This prospective, randomized, open-label, pilot study evaluated the effect of a pharmacy clinic visit focused on medication reconciliation and patient education after hospital discharge on the incidence of rehospitalization and ED visits and the resolution of medication discrepancies. Results: Of the 61 subjects included in the study, 33 (54%) had medication discrepancies identified at discharge. Fifty percent of medication discrepancies were resolved in subjects randomized to the pharmacist intervention arm compared with 9.5% in the usual care arm (P = .015). Patients randomized to the intervention arm had significantly lower rates of the primary composite outcome of 30-day rehospitalization and ED visits compared with the usual care arm (0% vs 40.5%, P < .001). Conclusion: A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care resource utilization in this pilot study.

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“…Sixteen (44%) had greater levels of involvement that included activities such as home visits, medication therapy management sessions, comprehensive medication reviews, motivational interviewing, identification and resolution of drug therapy problems, and patient education. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Twenty-three studies were randomized trials, [19][20][21][22][23][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44][54][55][56] with the remaining 13 studies consisting of various nonrandomized designs. 18,24,25,35,[45][46]…”

Section: Resultsmentioning

confidence: 99%

The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis

Lussier¹,

Evans²,

Wright³

et al. 2020

Journal of the American Pharmacists Association

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Effectiveness of a medication discharge plan for transitions of care from hospital to outpatient settings

Abstract: The rate of medication discrepancies was not decreased in patients whose MDP was provided to their community pharmacy and physician at the time of hospital discharge compared with the rate in patients who received usual care.

Cited by 36 publications

References 19 publications

Characteristics Associated With Postdischarge Medication Errors

Characteristics Associated With Postdischarge Medication Errors

Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions

The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis

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