Transitional care for high-risk elderly patients pre/post discharge by collaboration between general hospital and community pharmacy: a pilot study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Medication-related problems (MRPs) frequently occur during the discharge period. Elderly patients, particularly, are at high risk for these problems due to polypharmacy and the use of potentially inappropriate medications. The purpose of this study was to build and implement collaboration between general hospital and community pharmacies to address MRPs among high-risk elderly patients before/after discharge. Methods: This retrospective study was conducted between June and December of 2020. The inclusion criteria were patients with aged ≥65 years; residents of Jeonju; discharged from Jeonbuk National University hospital; either on medication of exceeding 10 medications (or high-risk medications) after hospitalization through the emergency room, or having severe illness. Patients received medication reconciliation and counselling by hospital pharmacists before discharge and home-visit pharmaceutical care as follow-up by community pharmacists after discharge. Results: Twenty-two patients agreed to home-visit pharmaceutical services. Fifteen and 11 patients completed the first and second home-visit pharmaceutical care service, respectively. Forty-two MRPs were identified in 15 patients. The types of high-frequency MRPs were incorrect administration of drug, adverse drug reactions, medication non-compliance, drug-drug interactions, lifestyle modifications, and expired medication disposal. After consultation with the pharmacist, 34 out of 42 MRPs were resolved. Conclusions: Transitional care for high-risk elderly patients before and after discharge was successfully built and implemented through a collaboration between general hospital and community pharmacies. This study suggests that home-visit pharmaceutical services may have positive effects on the safe use of drugs during the transition period; however, additional research is needed to expand on these findings.
Abstract
Background: Medication-related problems (MRPs) frequently occur during the discharge period. Elderly patients, particularly, are at high risk for these problems due to polypharmacy and the use of potentially inappropriate medications. The purpose of this study was to build and implement collaboration between general hospital and community pharmacies to address MRPs among high-risk elderly patients before/after discharge. Methods: This retrospective study was conducted between June and December of 2020. The inclusion criteria were patients with aged ≥65 years; residents of Jeonju; discharged from Jeonbuk National University hospital; either on medication of exceeding 10 medications (or high-risk medications) after hospitalization through the emergency room, or having severe illness. Patients received medication reconciliation and counselling by hospital pharmacists before discharge and home-visit pharmaceutical care as follow-up by community pharmacists after discharge. Results: Twenty-two patients agreed to home-visit pharmaceutical services. Fifteen and 11 patients completed the first and second home-visit pharmaceutical care service, respectively. Forty-two MRPs were identified in 15 patients. The types of high-frequency MRPs were incorrect administration of drug, adverse drug reactions, medication non-compliance, drug-drug interactions, lifestyle modifications, and expired medication disposal. After consultation with the pharmacist, 34 out of 42 MRPs were resolved. Conclusions: Transitional care for high-risk elderly patients before and after discharge was successfully built and implemented through a collaboration between general hospital and community pharmacies. This study suggests that home-visit pharmaceutical services may have positive effects on the safe use of drugs during the transition period; however, additional research is needed to expand on these findings.
참고문헌 (35)
- Herges JR, "Impact of collaborative clinician visits on postdischarge total cost of care in a polypharmacy population", Am J Health Syst Pharm, 77(22), pp.1859~1865 (2020)
- Sehgal V, "Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital", J Family Med Prim Care, 2(2), pp.194~199 (2013)
- Picker D, "The number of discharge medications predicts thirty-day hospital readmission : a cohort study", BMC Health Serv Res, 15, pp.282~ (2015)
- Leffler ME, "Medication-related readmission risk assessment in older adult patients", J Am Coll Clin Pharm, 2(6), pp.652~659 (2019)
- Fennelly JE, "Evaluation of clinical pharmacist services in a transitions of care program provided to patients at highest risk for readmission", J Pharm Pract, 33(3), pp.314~320 (2020)
- El Morabet N, "Prevalence and preventability of drug-related hospital readmissions : a systematic review", J Am Geriatr Soc, 66(3), pp.602~608 (2018)
- Jencks SF, "Rehospitalizations among patients in the Medicare fee-for-service program", N Engl J Med, 360(14), pp.1418~1428 (2009)
- Daliri S, "The effect of a pharmacyled transitional care program on medication-related problems postdischarge : A before-after prospective study", PLoS One, 14(3), pp.e0213593~ (2019)
- Bae-Shaaw YH, "Real-world evidence on impact of a pharmacist-led transitional care program on 30-and 90-day readmissions after acute care episodes", Am J Health Syst Pharm, 77(7), pp.535~545 (2020)
- Layman SN, "Implementation of a pharmacist-led transitional care clinic", Am J Health Syst Pharm, 77(12), pp.966~971 (2020)
- March KL, "Pharmacist transition-of-care services improve patient satisfaction and decrease hospital readmissions", J Pharm Pract, 35(1), pp.86~93 (2022)
- Snyder ME, "Evaluating the effects of a multidisciplinary transition care management program on hospital readmissions", Am J Health Syst Pharm, 77(12), pp.931~937 (2020)
- Miller D, "Pharmacistled transitions-of-care program reduces 30-day readmission rates for Medicare patients in a large health system", Am J Health Syst Pharm, 77(12), pp.972~978 (2020)
- Melody KT, "Optimizing care transitions : the role of the community pharmacist", Integr Pharm Res Pract, 5, pp.43~51 (2016)
- Ensing HT, "Problems with continuity of care identified by community pharmacists post-discharge", J Clin Pharm Ther, 42(2), pp.170~177 (2017)
- 박혜영, "우리나라의 다제약제 현황과 적정관리 방안에 대한 고찰", 한국임상약학회지, 28(1), pp.1~9 (2018), 한국임상약학회[DOI]
- Nam YS, "Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria : a cross-sectional population based study", BMC Geriatr, 16, pp.118~ (2016)
- Chang TI, "Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study", Sci Rep, 10(1), pp.18964~ (2020)
- 양소영, "올바른 약물 이용 지원 시범사업 성과 연구", 보건사회연구, 40(3), pp.563~591 (2020), 한국보건사회연구원[DOI]
- 서덕성, "종합병원 입원 노인 환자들의 입원 직전 다약제 복용 실태와 시사점", Annals of geriatric medicine and research, 16(3), pp.133~140 (2012), 대한노인병학회[DOI]
- Shin Jinyoung, "The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center", Journal of Korean Medical Science, 35(39), pp.1~11 (2020), 대한의학회[DOI]
- 박세진, "노인의료센터 다학제 팀의 약물 조정이 약물사용 및 약제비 절감에 미치는 효과", 병원약사회지, 36(4), pp.432~441 (2019), 한국병원약사회[DOI]
- Sturgess IK, "Community pharmacy based provision of pharmaceutical care to older patients", Pharm World Sci, 25(5), pp.218~226 (2003)
- George J, "Development and validation of the medication regimen complexity index", Ann Pharmacother, 38(9), pp.1369~1376 (2004)
- Libby AM, "Patient-level medication regimen complexity across populations with chronic disease", Clin Ther, 35(4), pp.385~398 (2013)
- 김성옥, "고혈압과 당뇨병 노인의 복약순응도와 이에 영향을 미치는 요인", 한국임상약학회지, 21(2), pp.81~89 (2011), 한국임상약학회
- Gruneir A, "Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm", Open Med, 5(2), pp.e104~ (2011)
- Choi HJ, "The internal current status and prospect of reports of adverse drug reactions of herbal medicine : The necessity of report of adverse drug reactions of herbal medicine and henceforth task", J Pharmacoepidemiol Risk Manag, 10(1), pp.1~8 (2018)
- Fugh-Berman A, "Herb-drug interactions", Lancet, 355(9198), pp.134~138 (2000)
- "Korea Food and drug statistical yearbook" (2020)[URL]
- 박수진, "국내 한약-양약 상호작용 연구논문 분석을 통한 상호작용 정보 현황파악 및 제공방안에 대한 연구", 동의생리병리학회지, 24(4), pp.543~552 (2010), 한의병리학회
- Lee S, "Development and validation of the Korean version of the medication regimen complexity index", PLoS One, 14(5), pp.e0216805~ (2019)
- Hawes EM, "Post-hospital discharge care : a retrospective cohort study exploring the value of pharmacistenhanced care and describing medication-related problems", N C Med J, 79(1), pp.4~13 (2018)
- Kelling SE, "Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population", Inov Pharm, 4(4), pp.137~ (2013)
- Monte SV, "Pharmacist home visits : A 1-year experience from a community pharmacy", J Am Pharm Assoc, 56(1), pp.67~72 (2016)
