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

Not Applicable

Completed

• Conditions: Patient Compliance; Readmission; Adverse Drug Event
• Interventions: Behavioral: HomeCoMe-program

• Registration Number: NCT01897870
• Lead Sponsor: H.T. Ensing, PharmD, MSc

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.

Study Timeline

• Study First Submitted: 2013-07-02
• Study First Submitted QC: 2013-07-09
• Study First Posted: 2013-07-12
• Study Start: 2013-11
• Status Verified: 2016-02
• Primary Completion: 2016-02
• Study Completion: 2016-02
• Last Update Submitted: 2016-02-22
• Last Update Posted: 2016-02-23

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 150

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
HomeCoMe-program group	HomeCoMe-program	the arm receiving the pharmacist home visit

Primary Outcome Measures

Name	Time	Method
Identifying and solving adverse drug events (ADEs) and other drug-related problems (DRPs) post-discharge	within 7 days post-discharge	The total number of assessed and solved ADEs post-discharge will be measured. Assessing and solving ADEs takes place during the pharmacist home visit.; Using START-STOPP criteria on patients medication records, ADEs will also be compared between the intervention and usual care group.

Secondary Outcome Measures

Name	Time	Method
Assessment of patient reported health rating	at 42 days after discharge	Patient are asked by telephone to report their health on a scale from 1 (worst imaginable health) to 10 (best imaginable health). Number are compared between the intervention and control group.
Types of interventions made at the pharmacist home visit	within 7 days after discharge	The types of intervention the pharmacist works on during the 7 day follow-up home visit are assessed.
Patient satisfaction with the pharmacist home visit	Immediately after receiving the home visit	The satisfaction survey consists of 13 interview questions, where the subject subjectively scores each question on a four-point scale, developed specifically for this study.
General practitioners satisfaction with the pharmacist home visit	Immediately after the home visit is executed	The satisfaction survey consists of 13 interview questions, where the subject subjectively scores each question on a four-point scale, developed specifically for this study.
Improvement of adherence to medication at hospital discharge	up to 6 months after discharge	The "medication possession ratio" will be calculated retrospectively from pharmacy dispensing data after 6 months to investigate patient's adherence and compared between the intervention and control group.
Patient assessment of medication knowledge at time of home visit	within 7 days after discharge	At time of the home visit patients are asked about their knowledge (e.g. indication, dose regime, etc) regarding the medication they are taking. Knowledge is scored and lack of knowledge is solved by teaching the patient.

Trial Locations

Locations (1)

Zorgapotheken Flevoland; 🇳🇱 Almere, Flevoland, Netherlands