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Effect of Medication Review and Counselling of Community Pharmacists of...

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Titel Effect of Medication Review and Counselling of Community Pharmacists of Patients discharged from the hospital on Medication safety and compliance
Looptijd 04 / 2007 - 04 / 2011
Status Afgesloten
Onderzoeknummer OND1326542
Leverancier gegevens Website ZonMw

Samenvatting (EN)

Aim: It is the aim of the proposed intervention study to investigate the effect of intensive medication review of the drugs used by patients discharged from the hospital with five or more drugs by community pharmacists on medication safety. Medication safety includes preventable DRP and re-hospitalisations, detected and prevented interactions and contraindications, check of the indication and check of dose. The effect of patient counselling by pharmacists after discharge from the hospital and several times during the first year following discharge on compliance is also studied.The cost-effectiveness of the intervention is also studied. Samenvatting Problem definition: Drug related problems (DRP) such as contra-indications, interactions, adverse drug reactions (ADR) and inefficacy of treatment not only result from the specific effects of drugs in patients but also from causes like prescription errors and non-compliance with treatment (1,2). DRP are often the underlying cause of hospital admissions(3). Risk factors for DRP include: ageing, co-morbidity, polypharmacy, non-compliance and hospitalisation. It has been observed that medication review by a pharmacist, patient counselling and follow-up by telephone after hospitalisation were associated with a lower rate of DRP. A systematic review of intervention studies in primary care aimed at reducing ADR found some evidence that pharmacist-initiated medication review is effective in reducing hospital admissions. More randomised controlled trials are needed to decide whether or not these interventions are effective in reducing hospital admissions. Interventions should be aimed at improving pharmacotherapy by means of effective strategies including intensive medication review and improvement of compliance.Aim of the study: To investigate the effect of intensive medication review of the drugs used by patients discharged from the hospital with five or more drugs and older than 60 years by community pharmacists on medication safety. The effect of patient counselling by pharmacists after discharge from the hospital and several times during the first year following discharge on compliance is studied. The cost-effectiveness of the intervention is also studied.Relevance: At discharge most patients with chronic diseases continue to use the drugs that they used in the hospital. Drug treatment at home may therefore consist of drugs newly prescribed at discharge, drugs prescribed in the hospital, and drugs used before admission. It is highly unlikely that all these drugs were prescribed by the same physician. Therefore, errors in the transfer of medication records and related information may cause unwanted changes of the drug regimen at admission. Systematic review of the medication at discharge by the community pharmacist will reduce the medication error rate and prevent the occurrence of certain DRP and hence increase drug safety. In view of the changes that the drug regimen in the hospital, once at home to the patient it is not always clear which drugs - prescribed or canceled but still in his or her possession, have to be used, why they have to be used or not, and how drugs of which the use is required, must be used. If pharmacies would check whether the drugs presribed at discharge fit in with other medication not affected by the hospital stay (part of intense medication review and in corroboration with the general practitioner), superfluous drugs are handed in, patients or carers are sufficiently counselled about the effects and side effects of the drugs prescribed at discharge and their exact use (and correct any omissions), and provide adequate and patient-tailored information, the occurrence of all kinds of possible DRP would be prevented at an early stage.Insufficient adherence to drug treatment may substantially decrease the efficacy of treatment and quality of life, result in unnecessary hospitalisation and hence in a considerable waste of money. It is therefore highly relevant to improve patient compliance. Polypharmacy also strongly increases the risk of DRP. It is therefore relevant to focus on (chronically-ill) elderly patients using five or more drugs. Because of the ageing of the population, the prevalence of co-morbidity and associated polypharmacy, which is a high risk for DRP, is increasing.To influence medication compliance we use elements from the theory of planned behaviour. Informed and shared decision making, as part of this theory are hallmarks of the quality of medical care. Decision counselling is a novel method that has been developed to address this need.MethodA randomised controlled study involving 345 patients. The patients are recruited by community pharmacists. Patients taking five or more prescribed medications at discharge, older than 60 years are eligible. Randomisation occurs at the level of FTOs (Local groups of pharmacists and general practitioners). Each pharmacy contributes 15 to 20 patients in subsequent order. The medication of the patients is reviewed by the pharmacist. Patients are asked to fill in a questionnaire containing questions about patients health state, attitude towards illness and medication and adherence. Patient are counselled by the pharmacist at home or in the pharmacy about the effects, side effects and use of the drugs and adherence. All patients receive a written outline of their rationalised drug regimen. Cancelled and superfluous drugs are taken in. During a period of one year patients are regularly counselled about adherence. Outcome measures: DRP, Re-hospitalisation, Pharmacists interventions, Attitude, Quality of life, Persistence with the drugs, Adherence, Cost-effectiveness estimate

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Betrokken personen

Projectleider Dr. J.G. Hugtenburg

Classificatie

A34800 Geneesmiddelen en bestrijdingsmiddelen
D23340 Biofarmaceutische wetenschappen, toxicologie

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