Multidisciplinary Team Utilizing Pharmacists in Multimodal, Bundled Care Reduce Chronic Obstructive Pulmonary Disease Hospital Readmission Rates

Buljac-Samardžić

et al. 2021

Front. Public Health

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals.Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality.Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive.Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.

Section: Discussionsupporting

confidence: 89%

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review

Buljac-Samardžić

et al. 2021

Front. Public Health

“…Hospital readmissions are a worldwide, major health-care burden, with a negative impact on patient health, public health, and healthcare systems' associated national financial burden. Previous publications describe the heavy toll of hospital (non-surgical) re-admissions while the same researchers and others attempted various strategies for either predicting the risk for readmission and proactively reducing it (albeit with conflicting results) [5][6][7][8][9][10].…”

Section: The Need For Internal Medicine Personalization Hospital Lenmentioning

confidence: 99%

Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

Anani

Goldhaber

Brom

et al. 2020

JCM

Background: Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized in internal medicine departments could help better prognosticate patients in the realm of internal medicine. Methods: During a 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood alanine-amino transferase (ALT) activity, and mid-arm muscle circumference (MAMC) measurements. Results: We recruited 980 consecutive patients upon hospital admission (median age 72 years (IQR 65–79); 56.8% males). According to the FRAIL questionnaire, 106 (10.8%) patients were robust, 368 (37.5%) pre-frail, and 506 (51.7%) were frail. The median ALT value was 19IU/L (IQR 14–28). The median MAMC value was 27.8 (IQR 25.7–30.2). Patients with low ALT activity level (<17IU/L) were frailer according to their FRAIL score (3 (IQR 2–4) vs. 2 (IQR 1–3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30 days readmission in the whole cohort was 17.4%. Frail patients, according to the FRAIL score (FS), had a higher risk for 30 days readmission (for FS > 2, HR = 1.99; 95CI = 1.29–3.08; p = 0.002). Frail patients, according to low ALT activity, also had a significantly higher risk for 30 days readmission (HR = 2.22; 95CI = 1.26–3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥4 days (for FS > 2, HR = 1.87; 95CI = 1.39–2.52; p < 0.001). Frail patients, according to low ALT activity, were also at higher risk for LOS ≥4 days (HR = 1.87; 95CI = 1.39–2.52; p < 0.001). MAMC values were not correlated with patients’ LOS or risk for re-admission. Conclusion: Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

“…10 Existing studies on collaborative COPD care models focused mainly on clinical pharmacists. 6,51 Considering the importance of continuity of care in improving COPD patient outcomes (including a reduction in all-cause mortality 52 ), a collaborative care model with guided practice protocols should be developed to integrate community pharmacists into the ongoing therapeutic support for COPD patients and to promote the understanding of and respect for pharmacists' potential to contribute, and most importantly, to guide good practice among pharmacists. 5,[53][54][55] To expand and consolidate the role of community pharmacists in managing COPD, it is important to demonstrate the added value of pharmacists' interventions on the overall disease management and the clinical outcome of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…One of the key reasons for this is that patients face many medication-related problems, including low medication adherence rates, 3,4 inability to use inhaler devices correctly, 5 and failure to take medication properly. 6 The medicationrelated issues that COPD patients face and the consistent care that they need to manage their chronic conditions highlight the importance of the professional role of pharmacists. 7 The responsibility of the pharmacist is no longer simple drug-adjustment work, but has been expanded to become patient-centric diversified health management.…”

Section: Introductionmentioning

confidence: 99%

<p>Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model</p>

Yao

Ung

et al. 2020

COPD

This study aimed 1) to identify and analyse the professional services provided by community pharmacists for chronic obstructive pulmonary disease (COPD) management; and 2) to develop a logic model for community pharmacy practice for COPD management. Methods: A systematic review with a logic model was applied. English-language databases (PubMed, Web of Science, Embase, and Scopus) and a Chinese database (CNKI) were searched for articles published between January 2009 and June 2019. Studies concerning pharmacists and COPD were identified to screen for studies that focused on professional services provided at a community pharmacy level. Evidence on economic, clinical, and humanistic outcomes of interventions was summarized. Results: Twenty-five articles were included in this study. Four categories of COPD-related interventions by community pharmacists were identified: 1) primary prevention; 2) early detection; 3) therapy management; and 4) long-term health management. The most common outputs examined were improvement in inhaler technique, medication adherence, and rate of smoking cessation. The clinical (improved quality of life, reduced frequency and severity of symptoms and exacerbation), humanistic (patient satisfaction), and economic (overall healthcare costs) outcomes were tested for some interventions through clinical studies. Contextual factors concerning pharmacists, healthcare providers, patients, facilities, clinic context, and socioeconomic aspects were also identified. Conclusion: Studies in the literature have proposed and examined different components of professional services provided by community pharmacists for COPD management. However, relationships among outcomes, comprehensive professional services of community pharmacists, and contextual factors have not been systematically tested. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacy practice for COPD management.