Intermediate Care: The Role of Medicines Management

Abstract

Healthcare systems worldwide are facing an unprecedented demographic change as globally, the number of older people will triple to 2 billion by the year 2050. The resulting pressures on acute services have been instrumental in the development of intermediate care (IC) as a new healthcare model, which has its origins in the National Health Service in the UK. IC is an umbrella term for patient services that do not require the resources of a general hospital but are beyond the scope of a traditional primary care team. IC aims to promote timely discharge from hospital, prevent unnecessary hospital admissions and reduce the need for long-term residential care by optimizing functional independence. Various healthcare providers around the world have adopted similar models of care to manage changing healthcare needs. Polypharmacy, along with age-related changes, places older people at an increased risk of adverse drug events, including inappropriate prescribing, which has been shown to be prevalent in this population in other healthcare settings. Medicines management (the practice of maximizing health through optimal use of medicines) of older people has been discussed in the literature in a variety of settings; however, its place within IC is largely unknown. Despite IC being a multidisciplinary healthcare model, there is a lack of evidence to suggest that enhanced pharmaceutical involvement is core to the service provided within IC. This review article highlights the gap in the literature surrounding medicines management within IC and identifies potential solutions aimed at improving patient outcomes in this setting.

Severity and Management of Drug–Drug Interactions in Acute Geriatric Patients

“…The shift towards an older and more multimorbid population will naturally put an extra load on the healthcare system, which already struggles to meet today`s demand (6,156…”

A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities.

“…Intermediate care (IC) is a care setting that has evolved over a number of years in response to the ageing population, the increasing pressure faced by acute healthcare services and the resulting need for alternatives to hospital-based care. Although the term 'IC' originated in the United Kingdom (UK), other countries have adopted similar strategies; several equivalent healthcare models with similar objectives to IC services are used globally and are denoted by a variety of terminologies including 'subacute care', 'post-acute care' and 'transition care' [1]. IC has been broadly defined in the UK as 'a range of integrated services to prevent unnecessary hospital admission, promote faster recovery from illness, support timely discharge and maximise independent living' [2].…”

A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

“…This finding is unsurprising given the confusion surrounding the terminology used to describe IC [1]. Despite its presence within the UK for over a decade, IC does not relate to a single healthcare service or setting [13].…”

“…Whilst various terminologies are used to describe similar care settings globally [1], IC is broadly defined in the United Kingdom (UK) as ‘a range of integrated services to prevent unnecessary hospital admission, promote faster recovery from illness, support timely discharge and maximise independent living’ [2]. Despite the importance placed on the concept of the multidisciplinary team in IC, previous work has highlighted how the pharmacy profession has not been integrated into this care setting [1, 3, 4]. This lack of pharmacy involvement is concerning, given that various aspects of medicines management within the IC setting may be suboptimal [3].…”