The transition of patients between different levels of healthcare presents a significant risk to medication safety, as deviations frequently occur during this process. The introduction of seamless care into the Slovenian healthcare system has provided a modern pharmacy service that significantly reduces this risk and improves overall patient care, consequently enhancing safety, quality, and efficiency in medication treatment. Several Slovenian hospitals, including the General Hospital Murska Sobota, have implemented seamless care services immediately after January 1, 2023, when it became legally mandatory in hospitals, to ensure continuous medication supply and pharmaceutical care during transitions between different levels of healthcare.
The purpose of this research was to evaluate the implementation of seamless care at the General Hospital Murska Sobota, providing insights into its execution while demonstrating the necessity for its continuation and further development. We analyzed specific services within the scope of seamless care upon admission and discharge of the patient from the hospital, as well as its continuation at the primary level of healthcare. A retrospective study was conducted, including all adult patients hospitalized in various hospital departments, who received seamless care services between January and August 2023. We reviewed medical records related to hospital treatment, where the first seamless care service was provided, including the discharge letter, pharmacotherapy report as part of seamless care, personal medication card, and the record of medication withdrawals from the patient's health insurance card.
Between January 1, 2023, and August 31, 2023, seamless care services were provided to 1,251 patients, with a total of 1,325 services performed. These were primarily conducted in the orthopedic, internal medicine, surgical, and infectious diseases departments, with the highest number of services in the orthopedic department (34.1%). Due to a shortage of hospital pharmacists, services had to be prioritized for patients who benefited the most from it. Thus, 98.9% of the services were provided to priority patient groups. The lack of staff significantly limited the scope of the service, as it was only provided to 14.7% of hospitalized patients. The highest proportion of patients received seamless care services in the orthopedic department (46.6%). The Regulation on Compulsory Health Insurance Service Programs, the Capacities Required for its Implementation, and the Scope of Resources for the Year 2023 restricted the provision of seamless care to patients hospitalized for at least 48 hours. Therefore, the service was provided only to patients expected to remain in the hospital for at least 48 hours. As a result, the majority of services (99.1%) were performed for patients whose hospitalization lasted 48 hours or more. Removing the condition regarding the duration of hospitalization would allow equal access to seamless care services for all patients. When issuing medications upon discharge, there was a limitation on the dispensed quantity – only one box of each newly introduced medication shall be provided, according to the regulation. The results of our analyses show, that at least one medication was dispensed to 28.2% of patients, with analgesics being the most frequently dispensed (70.2%). A large proportion of patients (75.1%) had to pick up their medications at an external pharmacy after discharge, indicating the need to issue the full quantity of newly prescribed medications, particularly time-sensitive ones, directly at the hospital. Discrepancies in therapy, which can lead to medication-related issues, numerous changes in therapy during hospitalization that increase the risk of unintended discrepancies, and a large proportion of patients with time-sensitive medications at discharge, where treatment continuity is crucial, highlight the need for seamless care services. Additionally, the high percentage of patients (82.2%) with therapy changes within a short period after discharge, for whom an update of the personal medication card is required, indicates the necessity of continuing seamless care at the primary level of healthcare.
Seamless care plays a significant and unique role in ensuring safe and quality patient treatment, not only at the hospital level but also in external pharmacies. Although the General Hospital Murska Sobota is among the leading hospitals in Slovenia in this field, there is still much room for improvement. A key step in this direction would be addressing the mentioned limitations regarding patient inclusion in seamless care services and the dispensing of medications upon hospital discharge.
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