The Effect of a Pharmacist Home Visit on Drug-related Problems Post-discharge. (HomeCoMe)

H.T. Ensing, PharmD, MSc

Status

Completed

Conditions

Adverse Drug Event

Patient Compliance

Readmission

Treatments

Behavioral: HomeCoMe-program

Study type

Interventional

Funder types

Other

Identifiers

NCT01897870

ZGA-1

Details and patient eligibility

About

the purpose of this study is to determine the the effect of a home-based medication management program on drug-related problems post-discharge.

Full description

Inaccuracy of medication histories and lack of knowledge on actual medication use results in confusion about medication regimens and medication mismanagement before- during - and after hospital admission. This phenomenon accounts for many readmissions, longer duration of admission and preventable and serious Adverse Drug Events (ADEs) as a result of Drug Related Problems (DRPs). Several studies show that discharge medication reconciliation (MR) and counseling by a pharmacy employee reduces the amount of discrepancies in the discharge prescription lists. Still, no unequivocal effect of MR on the occurrence of DRPs after discharge has been shown. This is due to a shift in underlying potential harmful discrepancies from mainly patient based (unintended nonadherence) to mainly system based (eg dispensing errors) and might be explained by (1) suboptimal transfer of information (2) an overload of information during a stressful situation and (3) difficulty to implement changes in medication at home. Therefore the reduction of DRPs, improvement of patients' medication knowledge and initial adherence can probably most effectively be addressed in a multifaceted integrated transmural intervention. Repetition of important information is the key to success. Moreover, the first weeks following hospital discharge are most crucial in preventing drug-related problems as patients could slip back in old medication schemes, or new problems may arise, such as emerging ADEs due to medication changes made during hospitalization.

Enrollment

150 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

patient uses more than three prescribed systemic drugs intended for chronic use at admission and discharge
patient has an expected length of stay of 48 hours or longer

Exclusion criteria

Patients admitted for scheduled chemotherapy
Patients admitted for radiation therapy
Patients admitted for transplantation
Patients transferred from another hospital
Patients transferred from another non-eligible ward within the same hospital
No informed consent signed
A live expectancy less than 6 months
Inability to be counselled (e.g. cognitive dysfunction, language constraints who cannot be solved with an interpreter)
Discharge to a nursing home (presuming dependence on medication administration)
If patients' community pharmacy is not participating in this study