scholarly journals The impact of including a medication review in an integrated care pathway: a pilot study

2021 ◽  
Author(s):  
Anaïs Payen ◽  
Claire Godard-Sebillotte ◽  
Nadia Sourial ◽  
Julien Soula ◽  
David Verloop ◽  
...  
Keyword(s):  
Older Adults ◽  
Integrated Care ◽  
Medication Review ◽  
Care Pathway ◽  
Hospital Readmissions ◽  
Potentially Inappropriate Medications ◽  
The Mean ◽  
Hospitalized Older Adults ◽  
Integrated Care Pathway ◽  
The Impact

Objective: Our hypothesis was that the intervention would decrease (or at least not increase) the number of potentially inappropriate medications (PIMs) and the number of hospital readmissions within 30 days of discharge per hospital stay. Methods: A cohort of hospitalized older adults enrolled in the PAERPA integrated care pathway (the exposed cohort) was matched retrospectively with hospitalized older adults not enrolled in the pathway (unexposed cohort) between January 1st, 2015, and December 31st, 2018. It was an analysis of French health administrative database. The inclusion criteria for exposed patients were admission to an acute care department in general hospital, age 75 or over, at least three comorbidities or the prescription of diuretics or oral anticoagulants, discharge alive, and performance of a medication review. Results: For the study population (n=582), the mean ± standard deviation age was 82.9 ± 4.9, and 190 (65.3%) were women. Depending on the definition used, the overall median number of PIMs ranged from 2 [0;3] upon admission to 3 [0;3] at discharge. The intervention was not associated with a significant difference in the mean number of PIMs. Patients in the exposed cohort were half as likely to be readmitted to hospital within 30 days of discharge, relative to patients in the unexposed cohort. Conclusion: Our results show that a medication review was not associated with a decrease in the mean number of PIMs. However, the integrated care intervention including the medication review was associated with a reduction in the number of hospital readmissions at 30 days.

Is Everything in the Garden Rosy? An Integrated Care Pathway for Acute Inpatient Mental Health Care, from Development to Evaluation: Part 2

2005 ◽  
Vol 9 (3) ◽  
pp. 101-105
Author(s):  
Robert Grant ◽  
Julie Hall ◽  
Roger Pritlove
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Integrated Care ◽  
Care Pathway ◽  
Service Users ◽  
Inpatient Mental Health ◽  
Integrated Care Pathway ◽  
Health Care Records ◽  
The Impact

This is the second paper of two, which considers the development, use and evaluation of an integrated care pathway (ICP) for acute inpatient mental health care. This paper reports an evaluation that was carried out to measure the impact of an ICP (described in Part 1) on the interventions it was designed to guide. The methodology used was pre- and post-ICP comparison of activities/care recorded in health-care records using delineating measures. Data were gathered from the notes of 23 service-users who had two inpatient stays within a year, one pre-ICP and one post-ICP. The findings suggested an overall improved provision of interventions, although as the ICP progressed the likelihood of receiving interventions fell. Three specific aspects were not affected by the ICP, these were giving information about observation levels to service-users, care planning and medical interventions. These issues are discussed and the conclusion raise implications for further ICP development and implementation.

scholarly journals Anticholinergic Burden Does Not Influence Delirium Subtype or the Delirium–Mortality Association in Hospitalized Older Adults: Results from a Prospective Cohort Study

Drugs & Aging ◽  
2021 ◽  
Author(s):  
Mark James Rawle ◽  
Laura McCue ◽  
Elizabeth L. Sampson ◽  
Daniel Davis ◽  
Victoria Vickerstaff
Keyword(s):  
Older Adults ◽  
Hospital Setting ◽  
Residential Home ◽  
Prescription Data ◽  
Subsyndromal Delirium ◽  
Increased Risk ◽  
The Mean ◽  
Hospitalized Older Adults ◽  
The Impact ◽  
Anticholinergic Burden

Abstract Background Anticholinergic burden (ACB) is associated with an increased risk of delirium in the older population outside of the acute hospital setting. In acute settings, delirium is associated with increased mortality, and this association is greater with full syndromal delirium (FSD) than with subsyndromal delirium (SSD). Little is known about the impact of ACB on delirium prevalence or subtype in hospitalized older adults or the impact on mortality in this population. Objectives Our objectives were to determine whether ACB moderates associations between the subtype of delirium experienced by hospitalized older adults and to explore factors (including ACB) that might moderate consequent associations between delirium and mortality in hospital inpatients. Methods We conducted a retrospective analysis of a cohort of 784 older adults with unplanned admission to a North London acute medical unit between June and December 2007. Univariate regression analyses were performed to explore associations between ACB, as represented by the Anticholinergic Burden Scale (ACBS), delirium subtype (FSD vs. SSD), and mortality. Results The mean age of the sample was 83 ± standard deviation (SD) 7.4 years, and the majority of patients were female (59%), lived in their own homes (71%), were without dementia (75%), and died between hospital admission and the end of the 2-year follow-up period (59%). Mean length of admission was 13.2 ± 14.4 days. Prescription data revealed an ACBS score of 1 in 26% of the cohort, of 2 in 12%, and of ≥ 3 in 16%. The mean total ACBS score for the cohort was 1.1 ± 1.4 (range 0–9). Patients with high ACB on admission were more likely to have severe dementia, to have multiple comorbidities, and to live in residential care. Higher ACB was not associated with delirium of either subtype in hospitalized older adults. Delirium itself was associated with increased mortality, and greater associations were seen in FSD (hazard ratio [HR] 2.27; 95% confidence interval [CI] 1.70–3.01) than in SSD (HR 1.58; 95% CI 1.2–2.09); however, ACB had no impact on this relationship. Conclusions ACB was not found to be associated with increased delirium of either subtype or to have a demonstrable impact on mortality in delirium. Prior suggestions of links between ACB and mortality in similar populations may be mediated by higher levels of functional dependence, greater levels of residential home residence, or an increased prevalence of dementia in this population.

scholarly journals Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Nuria Rodríguez-Núñez ◽  
Alberto Ruano-Raviña ◽  
Adriana Lama ◽  
Lucía Ferreiro ◽  
Jorge Ricoy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Integrated Care ◽  
Care Pathway ◽  
Quasi Experimental ◽  
Integrated Care Pathway ◽  
The Impact

Integrated Care Pathway for Acute Coronary Syndromes: Does It Help?

2008 ◽  
Vol 12 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Eylem Levelt ◽  
Barnaby Thwaites ◽  
Ghasem Yadegarfar
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Beta Blockers ◽  
Coronary Syndrome ◽  
Integrated Care Pathways ◽  
Coronary Syndromes ◽  
Coronary Care ◽  
Integrated Care Pathway ◽  
The Impact ◽  
Coronary Care Units

The use of integrated care pathways (ICPs) to enhance quality and consistency of patient care has increased in the last decade. In two closely related studies, we first assessed the benefit of a new ICP for acute coronary syndrome in our district hospital, and secondly assessed the impact of ICPs in UK coronary care units, correlating with data from the Myocardial Infarction National Audit Programme, MINAP. The new local ICP produced statistically improved admission medication, with the chance of correctly prescribing aspirin increasing by 63% ( P < 0.002), and borderline increase for clopidogrel of 28% ( P > 0.10), and enoxaparin of 21% ( P > 0.06), in a completed audit cycle study totalling 100 patients. A national telephone survey showed that of 210 UK coronary care units, only 40% had an ICP in place, and this made no difference to either door-to-needle time for thrombolysis or to rates of discharge medication with aspirin, beta-blockers or statins. While these results fail to raise enthusiasm for implementing an ICP, other potential benefits of their use may be important such as optimizing data collection, improving consistency of care and unifying the different clinical teams in planning the care of the patient.

scholarly journals Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

2021 ◽  
Vol 18 (8) ◽  
pp. 4370
Author(s):  
A Kim ◽  
Hayeon Lee ◽  
Eun-Jeong Shin ◽  
Eun-Jung Cho ◽  
Yoon-Sook Cho ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Medication Use ◽  
Potentially Inappropriate Medications ◽  
Management Service ◽  
Ckd Stage ◽  
The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

Patient quality criteria for a multidisciplinary integrated care pathway for von Hippel-Lindau syndrome

2021 ◽  
Vol 79 ◽  
pp. S295
Author(s):  
R. Giles ◽  
K. Dreijerink ◽  
R.S. Van Leeuwaarde ◽  
A.N. Van Der Horst-Schrivers ◽  
T.P. Links
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Quality Criteria ◽  
Von Hippel Lindau ◽  
Integrated Care Pathway ◽  
Von Hippel Lindau Syndrome
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