Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Site, and Setting
2.2. Patient Enrollment
2.3. Group Allocation
2.4. Baseline Assessment
2.5. Medication Reconciliation
2.6. Discharge Counseling
2.7. Phone Follow-Up
2.8. Outcome Measures
2.9. Data Management and Statistical Analysis
3. Results
3.1. Patient Demographics
3.2. Medication Utilization
3.2.1. Pre-Admission Medications
3.2.2. Discharge Medications
3.3. Identified DRPs and Clinical Significance
3.3.1. (Possible) Causes
3.3.2. Interventions and Acceptance
3.3.3. Medications Implicated in DRPs
3.3.4. Clinical Significance of DRPs Identified
3.4. Unplanned Health Care Utilization
3.5. Medication Adherence
3.6. Risk Factors of Occurrence of DRPs
3.7. Risk Factors Associated with Readmissions
4. Discussion
4.1. DRPs and Associated Risk Factors
4.2. Unplanned Health Care Utilization
4.3. Medication Adherence
4.4. Limitations
4.5. Implications
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
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Patient Demographics (n and %) | Intervention (n = 43) | Usual Care (n = 42) | p-Value @ | ||
---|---|---|---|---|---|
DRP Identified (n = 14) | Non-DRP Identified (n = 29) | Overall (n = 43) | |||
Age: mean ± SD | 82.1 ± 8.7 | 79.7 ± 8.0 | 80.5 ± 8.2 | 81.4 ± 8.1 | 0.597 + |
Age: median | 82 | 83 | 82 | 81 | 0.740 # |
Female gender | 11 (78.6%) | 17 (58.6%) | 28 (65.1%) | 25 (59.5%) | 0.595 # |
Chinese ethnicity | 14 (100%) | 29 (100%) | 43 (100%) | 42 (100%) | / |
With prior hospitalizations | 13 (92.9%) | 26 (89.7%) | 39 (90.7%) | 33 (78.6%) | 0.120 # |
Length of hospital stay: mean ± SD (days) | 47.8 ± 27.8 | 27.5 ± 18.6 | 34.1 ± 23.7 | 38.2 ± 38.7 | 0.552 + |
Principal diagnosis (n and %) | |||||
Stroke | 8 (57.1%) | 21 (72.4%) | 29 (67.4%) | 30 (71.4%) | 0.690 # |
ACS | 1 (7.1%) | 1 (3.4%) | 2 (4.7%) | 7 (16.7%) | 0.072 # |
HF | 5 (35.7%) | 7 (24.1%) | 12 (27.9%) | 5 (11.9%) | 0.065 # |
Medications Used | Intervention (n = 43) | Usual Care (n = 42) | p-Value @ | ||
---|---|---|---|---|---|
DRP Identified (n = 14) | Non-DRP Identified (n = 29) | Overall (n = 43) | |||
Number of pre-admission routine medications | |||||
Mean ± SD | 5.1 ± 2.7 | 4.5 ± 3.8 | 4.7 ± 3.5 | 5.1 ± 3.6 | 0.583 + |
Polypharmacy (n and %) | 9 (64.3%) | 14 (48.3%) | 23 (53.5%) | 25 (59.5%) | 0.575 # |
Total number of pre-admission medications: mean ± SD | 7.0 ± 3.4 | 5.6 ± 4.8 | 6.0 ± 4.4 | 6.8 ± 5.0 | 0.456 + |
Number of discharge routine medications | |||||
Mean ± SD | 7.1 ± 1.7 | 6.7 ± 2.0 | 6.8 ± 1.9 | 7.3 ± 2.9 | 0.334 + |
Polypharmacy (n and %) | 14 (100%) | 29 (100%) | 43 (100%) | 42 (100%) | / |
Total number of discharge medications: mean ± SD | 9.9 ± 2.8 | 8.2 ± 2.8 | 8.7 ± 2.9 | 9.3 ± 3.7 | 0.453 + |
Primary Domain | Cause | Case (%) | Case (%) |
---|---|---|---|
Drug selection: related to the selection of drug | Inappropriate drug according to guidelines/formulary | 5 (17.9) | 11 (39.3) |
No indication for drug | 3 (10.7) | ||
No drug treatment despite existing indication | 3 (10.7) | ||
Drug use process: related to the way patient gets the drug administered by a health professional or caregiver, despite proper dosage instructions given | Drug administered via wrong route | 9 (32.1) | 9 (32.1) |
Dose selection: related to the selection of dose or dosage | Dosage regimen too frequent | 2 (7.1) | 4 (14.3) |
Drug dose too low | 1 (3.6) | ||
Dose timing instructions wrong, unclear, or missing | 1 (3.6) | ||
Patient related: related to the patient and their behavior | Patient uses/takes more drug than prescribed | 1 (3.6) | 3 (10.7) |
Patient takes food that interacts | 1 (3.6) | ||
Patient stores drug inappropriately | 1 (3.6) | ||
Other | No obvious cause | 1 (3.6) | 1 (3.6) |
Primary Domain | Implementation | Case (%) | Case (%) |
---|---|---|---|
Intervention accepted | Intervention accepted and fully implemented | 47 (92.2) | 48 (94.1) |
Intervention accepted, partially implemented | 1 (2.0) | ||
Intervention not accepted | Intervention not accepted: unknown reason | 2 (3.9) | 3 (5.9) |
Intervention not accepted: not feasible | 1 (2.0) |
Adherence Category | Pre-Counseling (n = 34) | Post-Counseling (n = 43) | Changes | p-Value | OR (95% CI) |
---|---|---|---|---|---|
Low | 26 (76.5%) | 5 (11.6%) | −64.9% | <0.050 # | 0.04 (0.01–0.14) |
Medium | 4 (11.8%) | 20 (46.5%) | +34.7% | 0.001 # | 6.52 (1.96–21.72) |
High | 4 (11.8%) | 18 (41.9%) | +30.1% | 0.004 # | 5.40 (1.62–18.04) |
Mean ± SD | 4.94 ± 1.52 | 7.08 ± 1.03 | <0.001 + |
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Ip, R.N.S.; Tenney, J.W.; Chu, A.C.K.; Chu, P.L.M.; Young, G.W.M. Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial. Geriatrics 2018, 3, 53. https://doi.org/10.3390/geriatrics3030053
Ip RNS, Tenney JW, Chu ACK, Chu PLM, Young GWM. Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial. Geriatrics. 2018; 3(3):53. https://doi.org/10.3390/geriatrics3030053
Chicago/Turabian StyleIp, Rosanna Nga Suet, Justin Wade Tenney, Angus Chun Kwok Chu, Pauline Lai Ming Chu, and Grace Wai Man Young. 2018. "Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial" Geriatrics 3, no. 3: 53. https://doi.org/10.3390/geriatrics3030053