Header

UZH-Logo

Maintenance Infos

A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions


Brühwiler, Lea D; Beeler, Patrick E; Böni, Fabienne; Giger, Rebekka; Wiedemeier, Peter G; Hersberger, Kurt E; Lutters, Monika (2019). A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions. International Journal for Quality in Health Care:Epub ahead of print.

Abstract

Objective To improve discharge prescription quality and information transfer to improve post-hospital care with a pragmatic in-hospital service.
Design A single-centre, randomized controlled trial
Setting Internal medicine wards in a Swiss teaching hospital
Participants Adult patients discharged to their homes, 76 each in the intervention and control group.
Intervention Medication reconciliation at discharge by a clinical pharmacist, a prescription check for formal flaws, interactions and missing therapy durations. Important information was annotated on the prescription.
Main Outcome Measures : At the time of medication dispensing, community pharmacy documented their pharmaceutical interventions when filling the prescription. A Poisson regression model was used to compare the number of interventions (primary outcome). The significance of the pharmaceutical interventions was categorized by the study team. Comparative analysis was used for the significance of interventions (secondary outcome).
Results The community pharmacy staff performed 183 interventions in the control group, and 169 in the intervention group. The regression model revealed a relative risk for an intervention of 0.78 (95% CI 0.62-0.99, p=0.04) in the intervention group. The rate of clinically significant interventions was lower in the intervention group than in the control group (72 of 169 (42%) vs. 108 of 183 (59%), p<0.01), but more economically significant interventions were performed (98, 58% vs. 80, 44%, p<0.01).
Conclusions The pragmatic in-hospital service increased the quality of prescriptions. The intervention group had a lower risk for the need for pharmaceutical interventions, and clinically significant interventions were less frequent. Overall, our pragmatic approach showed promising results to optimize post-discharge care.

Abstract

Objective To improve discharge prescription quality and information transfer to improve post-hospital care with a pragmatic in-hospital service.
Design A single-centre, randomized controlled trial
Setting Internal medicine wards in a Swiss teaching hospital
Participants Adult patients discharged to their homes, 76 each in the intervention and control group.
Intervention Medication reconciliation at discharge by a clinical pharmacist, a prescription check for formal flaws, interactions and missing therapy durations. Important information was annotated on the prescription.
Main Outcome Measures : At the time of medication dispensing, community pharmacy documented their pharmaceutical interventions when filling the prescription. A Poisson regression model was used to compare the number of interventions (primary outcome). The significance of the pharmaceutical interventions was categorized by the study team. Comparative analysis was used for the significance of interventions (secondary outcome).
Results The community pharmacy staff performed 183 interventions in the control group, and 169 in the intervention group. The regression model revealed a relative risk for an intervention of 0.78 (95% CI 0.62-0.99, p=0.04) in the intervention group. The rate of clinically significant interventions was lower in the intervention group than in the control group (72 of 169 (42%) vs. 108 of 183 (59%), p<0.01), but more economically significant interventions were performed (98, 58% vs. 80, 44%, p<0.01).
Conclusions The pragmatic in-hospital service increased the quality of prescriptions. The intervention group had a lower risk for the need for pharmaceutical interventions, and clinically significant interventions were less frequent. Overall, our pragmatic approach showed promising results to optimize post-discharge care.

Statistics

Citations

Dimensions.ai Metrics

Altmetrics

Downloads

1 download since deposited on 22 May 2019
1 download since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
04 Faculty of Medicine > Center of Competence Multimorbidity
08 Research Priority Programs > Dynamics of Healthy Aging
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Public Health, Environmental and Occupational Health, Health Policy, General Medicine
Language:English
Date:14 May 2019
Deposited On:22 May 2019 13:50
Last Modified:17 Sep 2019 20:23
Publisher:Oxford University Press
ISSN:1353-4505
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/intqhc/mzz043
PubMed ID:31087065

Download

Content: Accepted Version
Filetype: PDF - Registered users only until 14 May 2020
Size: 313kB
View at publisher
Embargo till: 2020-05-14