Centre of Expertise Urban Vitality

The effect of a pharmacy-led transitional care program on medication-related problems post-discharge

a before-After prospective study


<p>BACKGROUND: Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge.</p><p>METHODS: A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data.</p><p>RESULTS: We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79).</p><p>CONCLUSIONS: A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.</p>

Reference Daliri, S., Hugtenburg, J. G., Ter Riet, G., van den Bemt, B. J. F., Buurman, B. M., Scholte Op Reimer, W. J. M., van Buul-Gast, M.-C., & Karapinar-Çarkit, F. (2019). The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: a before-After prospective study. PLoS ONE , 14(3), Article e0213593. https://doi.org/10.1371/journal.pone.0213593
Published by  Urban Vitality 12 March 2019

Publication date

Mar 2019


Sara Daliri
Jacqueline G Hugtenburg
Bart J F van den Bemt
Bianca M Buurman
Wilma J M Scholte Op Reimer
Marie-Christine van Buul-Gast
Fatma Karapinar-Çarkit


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