Pharmacist-led hospital intervention reduces unintentional patient-generated medication discrepancies after hospital discharge

Jošt, Maja (avtor), Knez, Lea (avtor), Kos, Mitja (avtor), Kerec Kos, Mojca (avtor)

Background: Medication reconciliation can significantly reduce clinically important medication errors at hospital discharge, but its impact on post-discharge medication management has not been investigated. We aimed to investigate the incidence of patient-generated medication discrepancies 30 days after hospital discharge and the impact of a pharmacist-led medication reconciliation coupled with patient counselling on clinically important discrepancies caused by patients. Methods: A pragmatic, prospective, controlled clinical trial was conducted at the University Clinic Golnik, Slovenia. Adult patients were divided into an intervention group and a control group. The intervention group received pharmacist-led medication reconciliation at admission and discharge, plus patient counselling at discharge. Medication discrepancies were identified by comparing the therapy prescribed in the discharge letters with the therapy 30 days after discharge, obtained through telephone patient interviews. Discrepancies were classified as intentional or unintentional, and their clinical importance was assessed. Results: The study included 254 patients (57.9% male, median age 71 years), with 136 in the intervention group and 118 in the control group. Discrepancies occurred with a quarter of the medicines (617/2,441; 25.3%) at 30 days after hospital discharge, and patients themselves caused half of the discrepancies (323/617; 52.4%), either intentionally (171/617; 27.7%) or unintentionally (152/617; 24.6%). Clinically important discrepancies occurred in 18.7% of intentional and 45.4% of unintentional patient-generated changes. The intervention significantly reduced the likelihood of clinically important unintentional patient-generated discrepancies (OR 0.204; 95%CI: 0.093–0.448), but not clinically important intentional patient-generated discrepancies (OR 2.525; 95%CI: 0.843–7.563). The latter were more frequent among younger, male patients and patients hospitalized for respiratory diseases. Conclusion: The study emphasizes the importance of addressing discrepancies made by patients after hospital discharge, which can result in potentially harmful outcomes. It also shows that a pharmacist-led hospital intervention can significantly reduce discrepancies in the early post-discharge period. These findings can guide the development of future services to improve patient support for medication management after hospitalization.

• Jezik: Angleški jezik
• Ključne besede: medication reconciliation, patient counselling, pharmacist-led intervention, transition of care, post-discharge therapy, medication discrepancies, patient-generated changes
• Vrsta gradiva: Članek v reviji
• Tipologija: 1.01 - Izvirni znanstveni članek
• Organizacija: FFA - Fakulteta za farmacijo
• Status publikacije: Objavljeno
• Različica publikacije: Objavljena publikacija
• Leto izida: 2024
• Št. strani: 9 str.
• Številčenje: Vol. 15, art. 1483932
• PID: 20.500.12556/RUL-164399
• UDK: 615.15:616-07/-08
• ISSN pri članku: 1663-9812
• DOI: 10.3389/fphar.2024.1483932
• COBISS.SI-ID: 212762883
• Datum objave v RUL: 24.10.2024

Gradivo je del revije

• Naslov: Frontiers in pharmacology
• Skrajšan naslov: Front Pharmacol
• Založnik: Frontiers Media
• ISSN: 1663-9812
• COBISS.SI-ID: 29551833

Licence

• Licenca: CC BY 4.0, Creative Commons Priznanje avtorstva 4.0 Mednarodna
• Povezava: http://creativecommons.org/licenses/by/4.0/deed.sl
• Opis: To je standardna licenca Creative Commons, ki daje uporabnikom največ možnosti za nadaljnjo uporabo dela, pri čemer morajo navesti avtorja.

Sekundarni jezik

• Jezik: Slovenski jezik
• Ključne besede: usklajevanje zdravil, svetovanje bolnikom, intervencija pod vodstvom farmacevta, prehodi oskrbe, terapija po odpustu, neskladja med zdravili, spremembe, ki jih povzroči bolnik, farmacevti, zdravstvena oskrba

Projekti

• Financer: ARIS - Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije
• Številka projekta: P1-0189
• Naslov: Farmacevtska tehnologija: od dostavnih sistemov učinkovin do terapijskih izidov zdravil pri otrocih in starostnikih

• Financer: ARIS - Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije
• Številka projekta: P3-0360
• Naslov: Celostna obravnava alergijskih bolezni in astme v Sloveniji: od epidemiologije do genetike