The Effect of a Pharmacist Home Visit on Drug-related Problems Post-discharge.

NCT ID: NCT01897870

Last Updated: 2016-02-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 150 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-11-30
• Study Completion Date: 2016-02-29

Brief Summary

the purpose of this study is to determine the the effect of a home-based medication management program on drug-related problems post-discharge.

Detailed Description

Inaccuracy of medication histories and lack of knowledge on actual medication use results in confusion about medication regimens and medication mismanagement before- during - and after hospital admission. This phenomenon accounts for many readmissions, longer duration of admission and preventable and serious Adverse Drug Events (ADEs) as a result of Drug Related Problems (DRPs). Several studies show that discharge medication reconciliation (MR) and counseling by a pharmacy employee reduces the amount of discrepancies in the discharge prescription lists. Still, no unequivocal effect of MR on the occurrence of DRPs after discharge has been shown. This is due to a shift in underlying potential harmful discrepancies from mainly patient based (unintended nonadherence) to mainly system based (eg dispensing errors) and might be explained by (1) suboptimal transfer of information (2) an overload of information during a stressful situation and (3) difficulty to implement changes in medication at home. Therefore the reduction of DRPs, improvement of patients' medication knowledge and initial adherence can probably most effectively be addressed in a multifaceted integrated transmural intervention. Repetition of important information is the key to success. Moreover, the first weeks following hospital discharge are most crucial in preventing drug-related problems as patients could slip back in old medication schemes, or new problems may arise, such as emerging ADEs due to medication changes made during hospitalization.

Conditions

Adverse Drug Event; Readmission; Patient Compliance

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: NONE

Study Groups

HomeCoMe-program group

the arm receiving the pharmacist home visit

Group Type: EXPERIMENTAL

HomeCoMe-program

Intervention Type: BEHAVIORAL

A home visit by patients own community pharmacist within seven days after hospital discharge. The community pharmacist will perform a semi-structured interview on (1) use of the prescribed medication, (2) ADEs, (3) adherence issues, by (A) assessing patient's needs and concerns around his pharmacotherapy, (B) identifying and solving obstacles for medicines intake, (C) checking on the need for a compliance aid, (D) collecting spare medication and finally (4) knowledge on medication use, when to take which medicine and why, and medication changes made during the hospitalisation.

Interventions

HomeCoMe-program

A home visit by patients own community pharmacist within seven days after hospital discharge. The community pharmacist will perform a semi-structured interview on (1) use of the prescribed medication, (2) ADEs, (3) adherence issues, by (A) assessing patient's needs and concerns around his pharmacotherapy, (B) identifying and solving obstacles for medicines intake, (C) checking on the need for a compliance aid, (D) collecting spare medication and finally (4) knowledge on medication use, when to take which medicine and why, and medication changes made during the hospitalisation.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• patient uses more than three prescribed systemic drugs intended for chronic use at admission and discharge
• patient has an expected length of stay of 48 hours or longer

Exclusion Criteria

• Patients admitted for scheduled chemotherapy
• Patients admitted for radiation therapy
• Patients admitted for transplantation
• Patients transferred from another hospital
• Patients transferred from another non-eligible ward within the same hospital
• No informed consent signed
• A live expectancy less than 6 months
• Inability to be counselled (e.g. cognitive dysfunction, language constraints who cannot be solved with an interpreter)
• Discharge to a nursing home (presuming dependence on medication administration)
• If patients' community pharmacy is not participating in this study

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Zorggroep Almere

OTHER

Sponsor Role: collaborator

Flevoziekenhuis

OTHER

Sponsor Role: collaborator

H.T. Ensing, PharmD, MSc

OTHER

Sponsor Role: lead

Responsible Party

H.T. Ensing, PharmD, MSc

PharmD, MSc

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Marcel L Bouvy, Prof, PharmD, PhD

Role: PRINCIPAL_INVESTIGATOR

UIPS

Locations

Zorgapotheken Flevoland

Almere Stad, Flevoland, Netherlands

Countries

Netherlands

References

Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006 Mar 13;166(5):565-71. doi: 10.1001/archinte.166.5.565.

Reference Type: BACKGROUND

PMID: 16534045 (View on PubMed)

Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002 Dec;54(6):657-64. doi: 10.1046/j.1365-2125.2002.01707.x.

Reference Type: BACKGROUND

PMID: 12492615 (View on PubMed)

Kwint HF, Faber A, Gussekloo J, Bouvy ML. The contribution of patient interviews to the identification of drug-related problems in home medication review. J Clin Pharm Ther. 2012 Dec;37(6):674-80. doi: 10.1111/j.1365-2710.2012.01370.x. Epub 2012 Aug 3.

Reference Type: BACKGROUND

PMID: 22861493 (View on PubMed)

Other Identifiers

ZGA-1

Identifier Type: -

Identifier Source: org_study_id