Medication review and patient counselling at discharge from the hospital by community pharmacists

Abstract

Aims In 2001, the Association of Amsterdam Community Pharmacists adopted a programme to improve the pharmaceutical care of patients who were discharged from hospital with five or more drug prescriptions. A comprehensive protocol for pharmaceutical care at discharge (IBOM-1) was developed. The aim of the study was to evaluate the initial IBOM protocol and to study the effects of the protocol on drug therapy and patient satisfaction as well as on drug use compliance and mortality. Method A controlled intervention study involving 37 community pharmacies and 715 of their registered patients who were discharged from a hospital and using at least five prescribed drugs in the years [2001][2002][2003]. The intervention included an extensive medication review and drug counselling at the patient's home. Main outcome measure Pharmacy intervention activities, changes in medication, discontinuation of drugs prescribed at discharge, mortality, time spent on the intervention activities, and medication cost savings were all evaluated. Patient satisfaction was measured by means of a questionnaire. Results 379 and 336 patients were enrolled in the intervention and control groups, respectively. The mean number of drugs per patient not dispensed, concomitantly dispensed, or of which the quantity was changed was higher in the intervention group than in the control group (0.70 ± 1.74 vs. 0.40 ± 1.43, 0.11 ± 0.40 vs. 0.038 ± 0.26, and 0.29 ± 1.05 vs. 0.097 ± 0.52, respectively). The mean number of drugs for which the dose or dosage form was changed was similar in both groups. Substitution of brand for generic or vice versa was greater in the intervention group. Changes resulting from a PAIS signal were similar in both groups. The mean number of drugs per patient for which contact was required with the physician or the Pharmacy Hospital Service Desk was higher in the intervention group (0.35 ± 0.51 vs. 0.16 ± 0.38). About 40% of home visits resulted in the clearing of redundant drug supplies. The IBOM-1 intervention did not influence discontinuation of drugs prescribed at discharge, nor did it influence mortality. Medication costs were slightly reduced. More patients of intervention pharmacies than of control pharmacies indicated that they were (very) satisfied with the drug counselling by their community pharmacist upon delivery of their discharge medication (87% vs. 50%; v 2 \ 0.001). Conclusions Structured pharmaceutical care according to the IBOM-1 protocol led to more changes in drug therapy. Home visits resulted in the clearing of redundant home drug supplies. In addition, patients were highly satisfied with the counselling at discharge from hospital by their community pharmacist. Patient counselling at discharge from hospital by pharmacists, therefore, appears to be a meaningful pharmaceutical care activity.

Drug-related problems in diabetes and transplant patients: an observational study with home visits

“…Recent studies indicated that pharmacist-conducted medication review and home visits are potentially beneficial [3,[8][9][10][11][12] but some randomised controlled trials failed to prove effectiveness [13][14][15][16]. It remains an open question if for particular diseases, tailored medication reviews by specifically trained pharmacists are needed.…”

“…Medication review carried out by a pharmacist has been shown to be an effective service to identify DRPs [3,9,10,[17][18][19][20]. However, not all DRPs can be detected by a review in the pharmacy [17].…”

Review of the cost-effectiveness of interventions to improve seamless care focusing on medication

“…Eight articles were selected for the review. Seven articles specifically explored approaches to improve seamless care focusing on medication [14][15][16][17][18]20]. In addition, one study described the study protocol for an economic evaluation, but did not present any results [21].…”

“…All but one study carried out an economic evaluation based on a randomized controlled trial [14,16,18,20] or an observational study [15,17,21]. Investigating the costeffectiveness of treatment alternatives in a trial setting provides a degree of internal validity.…”

“…A Dutch cost-effectiveness analysis evaluated an intervention targeted at patients using at least five prescribed medicines [17]. The intervention consisted of an extensive medication review and drug counselling at the patient's home following discharge.…”