Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a propective interventional study: 19-21 October 2022, Prague, Czech Republic

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Background and Objective: When geriatric patients are admitted for an orthopedic problem, their risk for complications is increased due to underlying chronic illness, chronic drug therapy and additive treatment changes requiring pharmacist counseling. The clinical pharmacist can counsel the patient and focus on transmural communication concerning polypharmacy to improve continuity of care after discharge by primary care providers. We assessed whether a pharmacist-led intervention aimed at optimizing transmural communication of drug-related problems (DRPs) to general practitioners (GPs), could lead to an additional DRP reduction in orthogeriatric patients. Method: An interventional study (pre-post design) was performed (October to December 2021 and January to March 2022). Orthopedic patients (≥65 years) were included. The pre-group received usual care, the post-group received the pharmacist-led transmural care program. Main outcome measures: The reduction of DRPs one month after discharge was calculated in both periods and, in addition, the GP acceptane rate was determined for the proposed interventions. Readmissions one month after discharge and the clinical impact of the pharmaceutical interventions (PIs) were evaluated, using the Clinical, Economic and Oganisational (CLEO) tool. Finally, it was determined whether the intervention, and other patient- or drug-related characteristics, influenced the DRP reduction rate. Results: Overall, 127 patients were included (control n=61, intervention n=66). The reduction of DRPs in the intervention period was statistically significantly higher than in the control period (p<0.001). In total, 141 interventions were suggested during the intervention period of which 58 (41%) were accepted at discharge and 42 (30%) were accepted one month after discharge when the GP was contacted, resulting in an overall acceptance rate of 71%. In both periods, four patients were readmitted one month after discharge. 70% of the PIs had a clinical impact (≥2C level according to CLEO-tool), indicating that they had the potential to avoid patient harm. The intervention (+1.750, (1.222-2.278), p<0.001) and number of DRPs at discharge (+0.530 (0.406-0.654), p<0.001) appeared to increase the DRP reduction rate significantly. Conclusion: The pharmacist-led transmural care program significantly reduced DRPs by optimizing transmural communication with GPs regarding the proposed interventions at discharge.
Originele taal-2English
Pagina's (van-tot)1464-1566
Aantal pagina's103
TijdschriftInternational Journal of Clinical Pharmacy
Volume44
Nummer van het tijdschrift6
DOI's
StatusPublished - 3 dec 2022
EvenementESCP 2022 Symposium: Polypharmacy and ageing - Prague, Czech Republic
Duur: 19 okt 202221 okt 2022

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This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine

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