Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a prospective interventional study

Background Orthogeriatric patients have an increased risk for complications due to underlying comorbidities, chronic drug therapy and frequent treatment changes during hospitalization. The clinical pharmacist (CP) plays a key role in transmural communication concerning polypharmacy to improve continuity of care by the general practitioner (GP) after discharge. In this study, a pharmacist-led transmural care program, tailored to orthogeriatric patients, was evaluated to reduce drug related problems (DRPs) after discharge. Methods An interventional study was performed (pre-period: 1/10/2021-31/12/2021; post-period: 1/01/2022-31/03/2022). Patients (≥ 65 years) from the orthopedic department were included. The pre-group received usual care, the post-group received the pharmacist-led transmural care program. The DRP reduction rate one month after discharge was calculated. Associated factors for the DRP reduction rate were determined in a multiple linear regression analysis. The GP acceptance rate was determined for the proposed interventions, as well as their clinical impact using the Clinical, Economic and Organizational (CLEO) tool. Readmissions one month after discharge were evaluated. Results Overall, 127 patients were included (control n = 61, intervention n = 66). The DRP reduction rate was statistically significantly higher in the intervention group compared to the control group (p < 0.001). The pharmacist’s intervention was associated with an increased DRP reduction rate (+ 1.750, 95% confidence interval 1.222–2.278). In total, 141 interventions were suggested by the CP, of which 71% were accepted one month after discharge. In both periods, four patients were readmitted one month after discharge. 58% of the interventions had a clinical impact (≥ 2 C level using the CLEO-tool) according to the geriatrician and for the CP it was 45%, indicating that they had the potential to avoid patient harm. Conclusions The pharmacist-led transmural care program significantly reduced DRPs in geriatric patients from the orthopedic department one month after discharge. The transmural communication with GPs resulted in a high acceptance rate of the proposed interventions..

Key messages Orthogeriatric patients are at increased risk for developing DRPs due to underlying comorbidities, polypharmacy, treatment changes during hospitalization, and limited expertise on complex pharmacotherapy among most surgeons. Several studies have shown a positive effect of CP interventions and multidisciplinary approaches on reducing DRPs. Even though a lot of studies recognize the importance of interdisciplinary collaboration to implement drug-specific recommendations, only a few have included the GP at discharge to discuss hospital-based recommendations. This study showed that a multifaceted pharmacist-led intervention with a primary care directed approach, proved to be effective in order to resolve DRPs and to ensure continuity of care after discharge. In future studies, the patient and community pharmacist should be actively involved to further reduce DRPs..

Medienart:	E-Artikel

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	Zur Gesamtaufnahme - volume:24
Enthalten in:	BMC geriatrics - 24(2024), 1 vom: 11. Jan.

Sprache:	Englisch

Beteiligte Personen:	Bailly, Rachel [VerfasserIn] Wuyts, Stephanie [VerfasserIn] Toelen, Loic [VerfasserIn] Mets, Tony [VerfasserIn] Van Hauwermeiren, Carmen [VerfasserIn] Scheerlinck, Thierry [VerfasserIn] Cortoos, Pieter-Jan [VerfasserIn] Lieten, Siddhartha [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	Clinical pharmacist Drug-related problems Interventional study Medication review Multidisciplinary approach Orthogeriatric patients Transmural care program

Anmerkungen:	© The Author(s) 2023

doi:	10.1186/s12877-023-04591-w

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	SPR05435644X