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Transitional care for high-risk elderly patients pre/post discharge by collaboration between general hospital and community pharmacy: a pilot study

  • Park, Mi Seon (Department of Pharmacy, College of Pharmacy, Chosun University) ;
  • Lee, Ji Hee (Department of Pharmacy, Jeonbuk National University Hospital) ;
  • Lee, Heung Bum (Internal Medicine, Research Center for Pulmonary Disorders, Jeonbuk National University Medical School and Hopital) ;
  • Kim, Ju Sin (Department of Pharmacy, Jeonbuk National University Hospital) ;
  • Choi, Eun Joo (Department of Pharmacy, College of Pharmacy, Chosun University)
  • Received : 2022.02.24
  • Accepted : 2022.03.17
  • Published : 2022.03.31

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.

Keywords

Acknowledgement

This study was supported by a research fund from Chosun University, 2020. The authors would like to specially thank Jeonju Pharmaceutical Association (JPA) for conducting the cooperation in this study.

References

  1. Herges JR, Borah BJ, Moriarty JP, Garrison GM, Gullerud RE, Angstman KB. Impact of collaborative clinician visits on postdischarge total cost of care in a polypharmacy population. Am J Health Syst Pharm 2020;77(22):1859-65. https://doi.org/10.1093/ajhp/zxaa192
  2. Sehgal V, Bajwa SJ, Sehgal R, Bajaj A, Khaira U, Kresse V. Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital. J Family Med Prim Care 2013;2(2):194-9. https://doi.org/10.4103/2249-4863.117423
  3. Picker D, Heard K, Bailey TC, Martin NR, LaRossa GN, Kollef MH. The number of discharge medications predicts thirty-day hospital readmission: a cohort study. BMC Health Serv Res 2015;15:282. https://doi.org/10.1186/s12913-015-0950-9
  4. Leffler ME, Elliott DP, Thompson S, Dean LS. Medication-related readmission risk assessment in older adult patients. J Am Coll Clin Pharm 2019;2(6):652-9. https://doi.org/10.1002/jac5.1104
  5. Fennelly JE, Coe AB, Kippes KA, Remington TL, Choe HM. Evaluation of clinical pharmacist services in a transitions of care program provided to patients at highest risk for readmission. J Pharm Pract 2020;33(3):314-20. https://doi.org/10.1177/0897190018806400
  6. El Morabet N, Uitvlugt EB, van den Bemt BJ, van den Bemt PM, Janssen MJ, Karapinar-Carkit F. Prevalence and preventability of drug-related hospital readmissions: a systematic review. J Am Geriatr Soc 2018;66(3):602-8. https://doi.org/10.1111/jgs.15244
  7. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360(14):1418-28. https://doi.org/10.1056/NEJMsa0803563
  8. Daliri S, Hugtenburg JG, Ter Riet G, et al. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-after prospective study. PLoS One 2019;14(3):e0213593. https://doi.org/10.1371/journal.pone.0213593
  9. Bae-Shaaw YH, Eom H, Chun RF, Steven Fox D. 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 2020;77(7):535-45. https://doi.org/10.1093/ajhp/zxaa012
  10. Layman SN, Elliott WV, Regen SM, Keough LA. Implementation of a pharmacist-led transitional care clinic. Am J Health Syst Pharm 2020;77(12):966-71. https://doi.org/10.1093/ajhp/zxaa080
  11. March KL, Peters MJ, Finch CK, et al. Pharmacist transition-of-care services improve patient satisfaction and decrease hospital readmissions. J Pharm Pract 2022;35(1):86-93. https://doi.org/10.1177/0897190020958264
  12. Snyder ME, Krekeler CE, Jaynes HA, et al. Evaluating the effects of a multidisciplinary transition care management program on hospital readmissions. Am J Health Syst Pharm 2020;77(12):931-7. https://doi.org/10.1093/ajhp/zxaa091
  13. Miller D, Ramsey M, L'Hommedieu TR, Verbosky L. Pharmacist-led transitions-of-care program reduces 30-day readmission rates for Medicare patients in a large health system. Am J Health Syst Pharm 2020;77(12):972-8. https://doi.org/10.1093/ajhp/zxaa071
  14. Melody KT, McCartney E, Sen S, Duenas G. Optimizing care transitions: the role of the community pharmacist. Integr Pharm Res Pract 2016;5:43-51. https://doi.org/10.4103/2279-042X.176559
  15. Ensing HT, Koster ES, van Berkel PI, van Dooren AA, Bouvy ML. Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther 2017;42(2):170-7. https://doi.org/10.1111/jcpt.12488
  16. Park HY, Sohn HS, Kwon JW. Reviews on the current status and appropriate management of polypharmacy in South Korea. Korean J Clin Pharm 2018;28(1):1-9. https://doi.org/10.24304/kjcp.2018.28.1.1
  17. Nam YS, Han JS, Kim JY, Bae WK, Lee K. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. BMC Geriatr 2016;16:118. https://doi.org/10.1186/s12877-016-0285-3
  18. Chang TI, Park H, Kim DW, et al. Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci Rep 2020;10(1):18964. https://doi.org/10.1038/s41598-020-75888-8
  19. Yang SY, Jang S, Kwon SH, et al. Effectiveness of the pilot project for polypharmacy management. Health and Social Welfare Review 2020;40(3):563-91. https://doi.org/10.15709/HSWR.2020.40.3.563
  20. Seo DS, Yoon JL, Kim SJ, Park JS, Lee WJ, Kim MY. Polypharmacy in older patients admitted to a general hospital. J Korean Geriatr Soc 2012;16(3):133-40. https://doi.org/10.4235/jkgs.2012.16.3.133
  21. Shin J, Han SH, Choi J, Kim YS, Lee J. The experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center. J Korean Med Sci 2020;35(39):e348. https://doi.org/10.3346/jkms.2020.35.e348
  22. Park S, Choi N, Seo Y, et al. The effects of medication reconciliation on drug use and cost-saving by multidisciplinary geriatric care team. J Korean Soc Health Syst Pharm 2019;36(4):432-41. https://doi.org/10.32429/jkshp.2019.36.4.001
  23. Sturgess IK, McElnay JC, Hughes CM, Crealey G. Community pharmacy based provision of pharmaceutical care to older patients. Pharm World Sci 2003;25(5):218-26. https://doi.org/10.1023/A:1025860402256
  24. George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother 2004;38(9):1369-76. https://doi.org/10.1345/aph.1D479
  25. Libby AM, Fish DN, Hosokawa PW, et al. Patient-level medication regimen complexity across populations with chronic disease. Clin Ther 2013;35(4):385-98.e1. https://doi.org/10.1016/j.clinthera.2013.02.019
  26. Kim SO. Medication adherence of elderly with hypertension and/or diabetes-mellitus and its' influencing factors. Korean J Clin Pharm 2011;21(2):81-9.
  27. Gruneir A, Dhalla IA, van Walraven C, et al. Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm. Open Med 2011;5(2):e104-11.
  28. 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 2018;10(1):1-8.
  29. Fugh-Berman A. Herb-drug interactions. Lancet 2000;355(9198):134-8. https://doi.org/10.1016/S0140-6736(99)06457-0
  30. Ministry of Food and Drug Safety. Korea Food and drug statistical yearbook. 2020. Available from https://www.mfds.go.kr/brd/m_371/view.do?seq=30719&srchFr=&srchTo=&srchWord=&srchTp=&itm_seq_1=0&itm_seq_2=0&multi_itm_seq=0&company_cd=&company_nm=&page=1. Accessed February 16, 2022.
  31. Park SJ, Kwon YK, Shin JG. Current status of herb-drug interaction information and information database in Korea. Journal of Physiology & Pathology in Korean Medicine 2010;24(4):543-52.
  32. Lee S, Jang JY, Yang S, et al. Development and validation of the Korean version of the medication regimen complexity index. PLoS One 2019;14(5):e0216805. https://doi.org/10.1371/journal.pone.0216805
  33. Hawes EM, Pinelli NR, Sanders KA, et al. Post-hospital discharge care: a retrospective cohort study exploring the value of pharmacist-enhanced care and describing medication-related problems. N C Med J 2018;79(1):4-13.
  34. Kelling SE, Bright DR, Ulbrich TR, Sullivan DL, Gartner J, Cornelius DC. Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population. Inov Pharm 2013;4(4):137.
  35. Monte SV, Passafiume SN, Kufel WD, et al. Pharmacist home visits: A 1-year experience from a community pharmacy. J Am Pharm Assoc 2016;56(1):67-72. https://doi.org/10.1016/j.japh.2015.11.002