Facilitating Home Hospice Transitions of Care in Oncology: Evaluation of Clinical Pharmacists’ Interventions, Hospice Program Satisfaction, and Patient Representation Rates

2018 ◽  
Vol 35 (9) ◽  
pp. 1181-1187 ◽  
Author(s):  
Alison P. Duffy ◽  
Nina M. Bemben ◽  
Jueli Li ◽  
James Trovato
Keyword(s):  
Medication Reconciliation ◽  
Transitions Of Care ◽  
Cancer Center ◽  
Discharge Process ◽  
Program Satisfaction ◽  
Discharge Medication ◽  
Pharmacist Interventions ◽  
Center Care ◽  
Discharge Readiness

Background: The importance of medication reconciliation and the pharmacist’s role within the interdisciplinary team at the point of transition to home hospice is understudied. A transitions of care pilot initiative was developed to streamline the transition for patients at end of life from inpatient cancer center care to home hospice. The initiative consisted of using a hospice discharge checklist, pharmacist-led discharge medication reconciliation in consultation with the primary team responsible for inpatient care, review of discharge prescriptions, and facilitation of bedside delivery of discharge medications. Methods: This was a single-center, prospective, pilot initiative. The objectives of this study were to characterize pharmacist interventions at the time of transition, to assess changes in hospice organizations’ perceptions of discharge readiness, and to evaluate differences in representation rates with the implementation of the pilot discharge process. Results: Fifteen patients in the preimplementation period and 12 patients in the postimplementation period were included. One hundred eleven pharmacist interventions were captured, an average of 9.3 interventions per patient, with an acceptance rate of 82.9% by providers. There was a statistically significant ( P = .035) improvement in hospice organizations’ perceptions of discharge readiness. There was no difference in 30-day representation rates postdischarge ( P = 1). Conclusion: This well-received pilot initiative demonstrated an improvement in local hospice’s perception of patient readiness for discharge and a high percentage of accepted pharmacist interventions during discharge medication reconciliation. A larger sample size of patients and longer follow-up period may be needed to demonstrate statistically significant improvements in representation rates postintervention.

Evaluation of Adverse Drug Events and Medication Discrepancies in Transitions of Care Between Hospital Discharge and Primary Care Follow-Up

2014 ◽  
Vol 29 (2) ◽  
pp. 132-137 ◽  
Author(s):  
Becky L. Armor ◽  
Avery J. Wight ◽  
Sandra M. Carter
Keyword(s):  
Primary Care ◽  
Hospital Discharge ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Transitions Of Care ◽  
Therapeutic Monitoring ◽  
Medication List ◽  
Medication Discrepancies

Approximately two-thirds of adverse events posthospital discharge are due to medication-related problems. Medication reconciliation is a strategy to reduce medication errors and improve patient safety. Objective: To evaluate adverse drug events (ADEs), potential ADEs (pADEs), and medication discrepancies occurring between hospital discharge and primary care follow-up in an academic family medicine clinic. Adult patients recently discharged from the hospital were seen by a pharmacist for medication reconciliation between September 1, 2011, and November 30, 2012. The pharmacist identified medication discrepancies and pADEs or ADEs from a best possible medication history obtained from the electronic medical record (EMR) and hospital medication list. In 43 study participants, an average of 2.9 ADEs or pADEs was identified ( N = 124). The most common ADEs/pADEs identified were nonadherence/underuse (18%), untreated medical problems (15%), and lack of therapeutic monitoring (13%). An average of 3.9 medication discrepancies per participant was identified (N = 171), with 81% of participants experiencing at least 1 discrepancy. The absence of a complete and accurate medication list at hospital discharge is a barrier to comprehensive medication management. Strategies to improve medication management during care transitions are needed in primary care.

scholarly journals Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

2020 ◽  
Vol 49 (4) ◽  
pp. 558-569 ◽  
Author(s):  
Justine Tomlinson ◽  
V-Lin Cheong ◽  
Beth Fylan ◽  
Jonathan Silcock ◽  
Heather Smith ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Older Patients ◽  
Medication Reconciliation ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Self Management ◽  
Multiple Time ◽  
Post Discharge

Abstract Background medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results twenty-four studies (total participants = 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.

scholarly journals Impact of a Pharmacy-Driven Transitions of Care Medication Reconciliation Following Hospitalization

2020 ◽  
Vol 36 (2) ◽  
pp. 68-71
Author(s):  
Rebecca L. Stauffer ◽  
Abigail Yancey
Keyword(s):  
Medication Reconciliation ◽  
Intervention Group ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Group ◽  
Medication Discrepancies ◽  
Institutional Review ◽  
The Impact ◽  
Medication Changes

Background: Medication changes are common after hospitalizations, and medication reconciliations are one tool to help identify potential medication discrepancies. Objective: To determine the impact of a pharmacy-driven medication reconciliation service on number of medication discrepancies identified. Methods: This was a retrospective cohort, chart-review study conducted at an internal medicine outpatient clinic. Patients at least 18 years of age were eligible for inclusion if they presented for a hospital follow-up appointment within 14 days of discharge between September 1, 2015, and May 31, 2016, from a system hospital. The 2 cohorts were patients with a pharmacist-completed medication reconciliation note written in the electronic health record on the date of their hospital follow-up appointment and those without. The primary outcome was number of medication discrepancies identified during medication reconciliation. Secondary outcomes included types of discrepancies, 30-day hospital readmission, and 30-day emergency department visits. This study was approved by the facility institutional review board. Results: Seventy-nine patients were included, and 38 patients had a pharmacist-completed medication reconciliation (48%). A total of 64 medication discrepancies were identified in 26 patients; of these, 49 discrepancies were resolved during the appointment (77%). There was an average of 2.46 medication discrepancies (±2.34) per patient. The most common discrepancy was missing medications. Thirty-day readmission rate was 5.3% in the intervention group and 19.5% in the control group ( P = .054). Conclusions: A pharmacist-completed medication reconciliation identified many medication discrepancies that were then resolved. From this study, pharmacist-led medication reconciliations following hospital discharge appear valuable.

Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice

2016 ◽  
Vol 22 (6) ◽  
pp. 757-765 ◽  
Author(s):  
Joseph D Ma ◽  
Victor Tran ◽  
Carissa Chan ◽  
William M Mitchell ◽  
Rabia S Atayee
Keyword(s):  
Palliative Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Practice ◽  
Cancer Type ◽  
Pharmacist Interventions ◽  
Medication Dose ◽  
Long Acting ◽  
Medication Changes

Background We have previously reported the development of an outpatient palliative care practice under pharmacist–physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients. Objective This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice. Methods This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed. Results Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients ( n = 80) were mostly women ( n = 44), had localized disease ( n = 42), a gastrointestinal cancer type ( n = 21), and were on a long-acting ( n = 61) and short-acting ( n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits. Conclusions A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits.

scholarly journals Improving medication reconciliation at hospital admission, discharge and ambulatory care through a transition of care team

2018 ◽  
Vol 7 (2) ◽  
pp. e000281 ◽  
Author(s):  
John Kreckman ◽  
Waiz Wasey ◽  
Sharron Wise ◽  
Tammy Stevens ◽  
Lance Millburg ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Medication Reconciliation ◽  
Care Team ◽  
Transitions Of Care ◽  
Ambulatory Setting ◽  
Transition Of Care ◽  
Early Recovery ◽  
Hospitalised Patients ◽  
Reconciliation Process

Medication reconciliation is an important component to the care of hospitalised patients and their safe transition to the ambulatory setting. In our Family Medicine Hospitalist Service, patient care is frequently transferred between the various physicians, residents, nurses and eventually to a separate group of providers who provide ambulatory management. Due to frequent transitions of care, there was no clear ownership of the medication reconciliation process. To improve the medication reconciliation process, a Transition of Care Team composed of registered nurses was created to oversee the entire reconciliation process. The team engaged the patient and their family, when needed, contacted patients’ pharmacies and their providers, reconciled the patients’ hospital medication list with the ambulatory list at hospital admission and within 24 hours of discharge, and attended the hospital follow-up visit to verify medications and provide continuity of care. Implementation of the team allowed for additional investigative resources, redundancy in preventing errors and early recovery should an error occur. The percent of medications with error after implementation of the Transition of Care Team was reduced from 131/386 (33.9%) to 147/787 (18.7%) at hospital admission, 81/354 (22.9%) to 42/834 (5.0%) at discharge and 43/337 (12.8%) to 6/809 (0.7%) at follow-up visit (two proportion tests, p<0.001). In addition, the percent of charts without any errors improved at hospital discharge from 8/31 (25.8%) to 46/70 (65.7%) and at hospital follow-up visit from 16/31 (51.6%) to 64/70 (91.4%) (two-proportion test, p<0.001). Previously viewed as three separate reconciliations occurring at admission, discharge and hospital follow-up, the approach to medication reconciliation was reframed as a continuous process occurring throughout the hospitalisation and hospital follow-up resulting in improved reconciliation accuracy and safer transitions to the ambulatory setting.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

scholarly journals Perceptions of a food benefit program that includes financial incentives for the purchase of fruits and vegetables and restrictions on the purchase of foods high in added sugar

2021 ◽  
pp. 1-24
Author(s):  
Fatima A Fagbenro ◽  
Tessa Lasswell ◽  
Sarah A Rydell ◽  
J Michael Oakes ◽  
Brian Elbel ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Fruits And Vegetables ◽  
Financial Incentive ◽  
Control Group ◽  
Added Sugar ◽  
Program Satisfaction ◽  
Food Purchasing ◽  
Households With Children ◽  
Participant Perspectives

ABSTRACT Objective To report perspectives of participants in a food benefit program that includes FAS restrictions and FAS restrictions paired with F/V incentives. Design Randomized experimental trial in which participant perspectives were an exploratory study outcome. Setting Participants were randomized into one of three SNAP-like food benefit program groups - (1) Restriction: not allowed to buy FAS with benefits; (2) Restriction paired with incentive: not allowed to buy FAS with benefits and 30% financial incentive on eligible F/V purchased using benefits; or (3) Control: Same food purchasing rules as SNAP. Participants were asked questions to assess program satisfaction. Participants Adults in the Minneapolis-St. Paul, MN metropolitan area, eligible for but not currently participating in SNAP who completed baseline and follow-up study measures (n=254). Results Among remaining households in each group, most found the program helpful in buying nutritious foods (88.2%-95.7%) and were satisfied with the program (89.1%-93.0%). Sensitivity analysis results indicate that reported helpfulness and satisfaction with the program may in some instances be lower among the Restriction and the Restrictions paired with Incentive groups in comparison to the control group. Conclusions A food benefit program that includes restriction on purchase of FAS or restriction paired with a financial incentive for F/V purchases may be acceptable to most SNAP-eligible households with children.

scholarly journals Development and evaluation of the Good Grief program for young people bereaved by familial cancer

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Pandora Patterson ◽  
Fiona E. J. McDonald ◽  
Elizabeth Kelly-Dalgety ◽  
Bianca Lavorgna ◽  
Barbara L. Jones ◽  
...  
Keyword(s):  
Social Support ◽  
Personal Growth ◽  
Unmet Needs ◽  
Meaning Making ◽  
Familial Cancer ◽  
Psychosocial Needs ◽  
Program Satisfaction ◽  
Death Of A Parent

Abstract Background Adolescents and young adults (AYAs) bereaved by the death of a parent or sibling from cancer report unique psychosocial needs and can have difficulty adjusting to their loss. Unaddressed, this can result in poor long-term bereavement outcomes. This paper describes the development and evaluation of Good Grief – a 3-day camp-based program focused on meeting coping, social support, and respite needs of AYAs bereaved by familial cancer. Methods One hundred and nine Australian AYAs (68% female; age: 12–25 years, M = 16.63) participated in the evaluation. Grief intensity (Texas Revised Inventory of Grief), meaning-making (Grief and Meaning Reconstruction Inventory), trauma coping (Perceived Ability to Cope with Trauma Scale) and unmet needs (Bereaved Cancer Needs Instrument) measures were administered pre-program and 3-months post-program. Acceptability was measured after each session and at the program’s conclusion. Appropriateness was measured at 3-month follow-up. Thirteen participants were interviewed three months post-program on their perceptions of the program. Results Participants reported high program satisfaction, engagement with psychosocial sessions, and enjoyment of recreational activities. Significant improvements were observed in trauma coping abilities and reductions in unmet needs for managing emotions, social support, respite, future planning, and accessing information and support domains. No change was evident in grief intensity or meaning-making as measured quantitatively. Interviews supported these quantitative findings but also identified evidence of personal growth, a component of meaning-making. Conclusions Good Grief is a highly acceptable and beneficial intervention that addresses the unique needs of AYAs bereaved by familial cancer.

scholarly journals Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lamis R. Karaoui ◽  
Elsy Ramia ◽  
Hanine Mansour ◽  
Nisrine Haddad ◽  
Nibal Chamoun
Keyword(s):  
Tertiary Care ◽  
Intervention Group ◽  
Bleeding Event ◽  
Transitions Of Care ◽  
Control Group ◽  
Published Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
The Impact

Abstract Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

scholarly journals Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months—a comparative study

2021 ◽  
Author(s):  
J. Frikkel ◽  
M. Beckmann ◽  
N. De Lazzari ◽  
M. Götte ◽  
S. Kasper ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Physical Functioning ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Psychological Conditions ◽  
Patient Reported

Abstract Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017

Sign in / Sign up

Export Citation Format

Share Document