Pharmacist-Provided Medication Management in Interdisciplinary Transitions in a Community Hospital (PMIT)

Rafferty, Aubrie; Denslow, Sheri; Michalets, Elizabeth Landrum

doi:10.1177/1060028016653139

Cited by 17 publications

(41 citation statements)

References 27 publications

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“…A systematic review investigating economic evaluations of clinical pharmacist interventions found an overall positive impact on hospital budgets; however, the quality of the included studies was limited . The studies in this review mostly found a positive effect on cost using methods such as reduced costs from readmissions and bed‐days where the cost of the time for the pharmacist‐led intervention was subtracted. Only one study performed a robust cost‐effectiveness analysis, which did not find a significant effect .…”

Section: Discussionmentioning

confidence: 94%

“…. In total, 11,896 publications were imported, 544 full texts were read, and 28 publications were included in the analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The total amount of patients in the 28 studies was 18.113 patients. For four studies, the number of patients in the intervention and control group was purposefully dissimilar . All 28 studies included adults, and the mean age ranged from 58 to 85 years.…”

Section: Resultsmentioning

confidence: 99%

“…Effect on hospital visits either as ED visits, readmissions or drug‐related hospital visits was investigated in 16 studies of 14,607 (table ) . Of these, seven studies of 4866 patients (n = 16; 44%) reported a significant positive difference . The remaining nine studies of 9741 patients reported a non‐significant result .…”

Section: Resultsmentioning

confidence: 99%

“…Economic outcome was investigated by four studies. Of these, three studies of 2806 patients reported a reduction in cost of hospital care by calculating the saved LOS of readmissions against the cost of pharmacy staff; however, they did not perform a statistical analysis .…”

Section: Resultsmentioning

confidence: 99%

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Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Skjøt‐Arkil

Lundby

Kjeldsen³

et al. 2018

Basic Clin Pharma Tox

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Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

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Section: Discussionmentioning

confidence: 94%

“…. In total, 11,896 publications were imported, 544 full texts were read, and 28 publications were included in the analysis.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Skjøt‐Arkil

Lundby

Kjeldsen³

et al. 2018

Basic Clin Pharma Tox

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Quality measures of clinical pharmacy services during transitions of care

King

Burkhardt

Rafferty

et al. 2021

J Am Coll Clin Pharm

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The impact of clinical pharmacy transitions of care (TOC) services on relevant quality measures (QMs) has been a major focus in the recent biomedical literature. The 2020 ACCP Transitions of Care Task Force was charged with updating a 2012 white paper that focused on process indicators of quality clinical pharmacy services during TOC. The Task Force extensively reviewed the recent literature and regulatory measures relevant to TOC services. Given the wide heterogeneity and apparent uncertainty in these measures, the Task Force identified a need to define broader groupings for QMs so that pharmacy TOC services could more be reliably compared across various institutions and practice settings. The Task Force recommends QMs for the processes used to identify, and ultimately resolve, medication discrepancies (QM‐1) and medication therapy problems (MTPs) (QM‐2). Although interventions through various processes can be used to resolve medication discrepancies and MTPs, the findings of these interventions are closely aligned with the major outcomes from these TOC services. Therefore, the Task Force strongly recommends that the successful resolution of medication discrepancies and MTPs be studied for their potential roles as intermediate, or surrogate, QMs (iQM‐1, iQM‐2, respectively) because these are most likely to directly influence or predict quality related to major outcomes from TOC services. In addition, three QMs related to major outcomes are recommended, which are consistent with the triple aim: QM‐3: Health Care Utilization (HCU), QM‐4: Satisfaction and Engagement, and QM‐5: Economics. QM‐3, QM‐4, and QM‐5 span patient‐centered outcomes to institutional, or clinician‐based, outcomes. Specific metrics used for each QM are recommended. In addition to highlighting confounding variables affecting findings in the recent literature, broader contextual considerations that may support TOC services or span multiple practice settings are summarized. Future studies must adopt standard QMs and seek to understand the potential of iQMs to accurately predict success within major patient‐centered and institutional outcomes.

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Prevalence and severity of discharge medication discrepancies resolved by pharmacists at a veterans affairs teaching hospital

Muller

Baric

Kohmescher

et al. 2022

J Am Coll Clin Pharm

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Introduction Although reassuring outcome data exist, not all pharmacist discharge efforts have been effective. This may be explained by heterogenous medication reconciliation definitions and processes. At a Veterans Affairs Teaching Hospital, Clinical Pharmacy Specialists (CPS) review the discharge medication reconciliation as part of a multidisciplinary process. The objective of this study is to describe CPS' role in resolving discharge medication reconciliation discrepancies and to evaluate potential patient harm avoided through pharmacist intervention. Methods Patients discharged home on at least one medication between October 21, 2021 and February 16, 2022 were included in this prospective single cohort study at a Veterans Affairs Hospital. Medication discrepancies were recorded. A panel of independent pharmacists categorized the clinical impact of discrepancies based on the potential to cause patient discomfort or clinical deterioration had the discrepancy gone unresolved: unlikely (class I), moderate (class II), or severe (class III). Results A total of 300 discharges were evaluated and 546 discrepancies identified. A majority (n = 202, 67.3%) of discharges had a discrepancy, with an average of 1.8 (SD ± 2.4) discrepancies per discharge. Pharmacists provided education during 84.3% of discharges and spent an average of 21.7 (SD ± 16.7) minutes per discharge. Panelists identified 359 (65.8%) class I, 149 (27.3%) class II, and 38 (7%) class III discrepancies. Omitted medication and incorrect dosing discrepancies conferred highest risk for potential patient harm. An increase in the number of medication changes from admission to discharge was the only variable predictive of discrepancies at discharge. Conclusion Pharmacists play a vital role at hospital discharge by resolving discrepancies and mitigating potential adverse outcomes. Designing discharge systems that prevent omitted medication and incorrect dosing discrepancies may be beneficial as these errors had the largest potential clinical impact; however, this hypothesis was unable to be tested in this study and deserves further research.

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Pharmacist-Provided Medication Management in Interdisciplinary Transitions in a Community Hospital (PMIT)

Cited by 17 publications

References 27 publications

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Quality measures of clinical pharmacy services during transitions of care

Prevalence and severity of discharge medication discrepancies resolved by pharmacists at a veterans affairs teaching hospital

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