An investigation of the opinions of community and hospital pharmacists and general practitioners of the management of drug therapy at the primary-secondary care interface


ABSTRACT Introduction: Drug-related problems and medication errors, many preventable, are known to make a significant contribution to morbidity and mortality. The point of transfer between primacy and secondary care provides significant opportunities for medication errors to arise, especially in the absence of structured transfer protocols. There has been limited national and international research into mechanisms to facilitate seamless transfer across the primary-secondary care interface. This study attempts to identify the current arrangements that are in place and the opinions of healthcare professionals of those arrangements. Materials & Methods: The opinions of community pharmacists, hospital pharmacists and general practitioners in relation to the current procedures in place for the admission and discharge of patients, with particular reference to drug therapy, were sought. This was done by means of self-administered, anonymous, postal questionnaires which were distributed nationwide. The data were coded and analysed in SPSS v. 16. Standard statistical parameters were calculated and statistically significant relationships were determined using ANOVA and the chi-squared test where appropriate, taking p<0.05 to be significant. Results: There is currently very little communication across the interface at the time of discharge, with 10.7% of community pharmacists reporting that they have never been contacted by a hospital to inform them of the imminent discharge of a patient, with a further 79.8% stating that they were only contacted occasionally. On the other side of the interface, hospital pharmacists reported ongoing difficulties in attempting to obtain a patient medication history on admission, with 75.5% of respondents stating that they regularly, often or always encountered these difficulties. Discussions, Conclusion: The majority of community and hospital pharmacists and general practitioners were dissatisfied with the management of drug therapy during the hospital discharge process. All three groups of healthcare professionals felt that the introduction of a structured seamless care programme linking hospitals, general practitioners and community pharmacists to be important or very important. It is intended that the results of this analysis will feed into a protocol for a pilot seamless care programme based in the community pharmacy.

Download full-text


Available from: Sheila Ryder, Sep 25, 2015
1 Follower
40 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of heart failure is increasing in developed countries. In the aged population, heart failure is a common cause of hospitalization and hospital readmission, which in conjunction with post-discharge care, impose a significant cost burden. Inappropriate medication management and drug-related problems have been identified as major contributors to hospital readmissions. In order to enhance the care and clinical outcomes, and reduce treatment costs, heart failure disease management programmes (DMPs) have been developed. It is recommended that these programmes adopt a multi-disciplinary approach, and pharmacists, with their understanding and knowledge of medication management, can play a vital role in the post-discharge care of heart failure patients. The aim of this literature review was to assess the role of pharmacists in the provision of post-charge services for heart failure patients. An extensive literature search was undertaken to identify published studies and review articles evaluating the benefits of an enhanced medication management service for patients with heart failure post-discharge. Seven studies were identified evaluating 'outpatient' or 'post-discharge' pharmacy services for patients with heart failure. In three studies, services were delivered prior to discharge with either subsequent telephone or home visit follow-up. Three studies involved the role of a pharmacist in a specialist heart failure outpatient clinic. One study focused on a home-based intervention. In six of these studies, positive outcomes, such as decreases in unplanned hospital readmissions, death rates and greater compliance and medication knowledge were demonstrated. One study did not show any difference in the number of hospitalizations between intervention and control groups. The quality of evidence of the randomized controlled trials was assessed using the Jadad scoring method. None of the studies achieved a score of more than 2, out of a maximum of 5, indicating the potential for bias. The DMPs carried out by pharmacists have contributed to positive patient outcomes, which has highlighted the value of extending the traditional roles of pharmacists from the provision of professional guidance to the delivery of continuity of care through a more holistic and direct approach. This review has demonstrated the effectiveness of pharmacists' interventions to reduce the morbidity and mortality associated with heart failure. However, there is an on-going need for the development and evaluation of pharmacy services for these patients.
    Journal of Clinical Pharmacy and Therapeutics 09/2007; 32(4):343-52. DOI:10.1111/j.1365-2710.2007.00827.x · 1.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors retrospectively evaluated anonymously submitted inpatient medical error reports from 8 institutions participating in the University HealthSystem Consortium Patient Safety Net (PSN) in 2004 in an attempt to focus patient safety efforts on problems that were most commonly associated with harm. Of the 25,300 incidents reported, 3381 (13.3%) were associated with adverse events (AEs), and 109 (0.4%) were associated with death. Although the most commonly reported categories of incidents associated with AEs were complications of procedure/treatment/test (29%), falls (17%), and medication errors (10%), the taxonomy of the PSN limited efforts to find specific errors in care that might be addressed by attempts to improve patient safety. Skin breakdown and falls were confirmed as presenting substantial risks to hospitalized patients, in that 59% of the incidents reported in the skin integrity category and 22% of falls resulted in AEs. The benefits and limitations of a voluntary reporting system are discussed.
    American Journal of Medical Quality 10/2009; 24(6):520-4. DOI:10.1177/1062860609345788 · 1.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission. Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients' number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness. Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient's age > or = 65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14-1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19-0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at admission was beneficial. Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.
    Journal of General Internal Medicine 02/2010; 25(5):441-7. DOI:10.1007/s11606-010-1256-6 · 3.42 Impact Factor