Post-discharge medication reviews for patients with heart failure: a pilot study

Abstract

This study provides evidence for the feasibility of a post-discharge pharmacy service for patients with heart failure although barriers to implementation have been identified.

Clinical medication review in Australia: A systematic review

“…65,79 Key processes A range of CMR models were evaluated. This included CMRs which involved pharmacist 22,44,53 Findings of qualitative work also supported these referral pathways, with stakeholders highlighting the use of pharmacists, nursing staff and other health providers as sources for CMR referrals. 63,64 Studies also reported CMRs undertaken by an accredited pharmacist working in a medical practice, 10,33,42,45 or as part of an ACAT (n ¼ 2), 23,51 community mental health team (n ¼ 1), 35,63 or palliative care team (n ¼ 1).…”

“…10,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44][46][47][48][49][50][52][53][54][55][56][57][58][59][60][61] Some studies investigated CMR in particular demographic groups including older people (R65 years, n ¼ 10) 24,31,[45][46][47][48]51,[55][56][57] and war veterans, widows and dependents (n ¼ 5). 52,[55]…”

“…36 Patients admitted to or recently discharged from hospital were also targeted for CMR post-discharge (n ¼ 12). 20,22,26,28,32,38,39,41,44,53,56,61 Polypharmacy was a common eligibility criteria (n ¼ 6), 20,[23][24][25][26]58 with eligibility criteria ranging from current use of two to greater than 20 subsidized prescriptions in the previous six months. The impact of CMR in patients taking specific medications was investigated, including those on warfarin (n ¼ 3), 28,41,57 anti-diabetic medications (n ¼ 2), 25,26 and other high-risk medications (n ¼ 1).…”

Medication Errors in Acute Cardiovascular and Stroke Patients

“…Because heart failure medications are titrated rapidly during hospitalization, accurate prescriptions that pay attention to dosing, electrolyte management, and monitoring of renal function are important shortly after discharge. 69 It is well accepted that the institution of optimal heart failure pharmacological therapy during hospitalization is associated with improved outpatient adherence. 70,71 …”

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

“…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.…”