scholarly journals Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 128
Author(s):  
Alaina Stroud ◽  
Georges Adunlin ◽  
Jessica W. Skelley
Keyword(s):  
Medication Adherence ◽  
Transitional Care ◽  
Care Service ◽  
Hospital Environment ◽  
Phone Call ◽  
Transition Of Care ◽  
Management Service ◽  
Adherence To Medication ◽  
Discharge Medication

This study assesses the effectiveness of a pharmacy-led transition of care (TOC) service on increasing patients’ understanding of, and reported adherence to, medication post hospital discharge. A cross-sectional survey was administered to patients who were discharged from the hospital with at least one medication received via bedside delivery from the TOC service. Adherence was assessed by asking the patient if they had taken their discharge medications as instructed by the prescriber. Satisfaction with the discharge medication counseling service was assessed through a five-point Likert scale. Descriptive statistics were conducted for all questionnaire items and qualitative data was examined using content analysis. The majority of patients (73%) were counseled on their medication(s) before leaving the hospital. Among those who received counseling, 76 patients had a better understanding of their medication(s). Ninety-five percent of the patients reported adherence, and all six of the patients reporting non-adherence claimed they were not counseled on their medications prior to discharge. Many patients had questions regarding their medication during the follow-up phone call, substantiating the need for further follow-up with patients once they have left the hospital environment. The implementation of medication bedside delivery and counseling services, followed by outpatient adherence monitoring via a transitional care management service, can result in higher levels of reported medication adherence.

Patterns of drug therapy, glycemic control, and predictors of escalation – non-escalation of treatment among diabetes outpatients at a tertiary care center

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shubham Atal ◽  
Rajnish Joshi ◽  
Saurav Misra ◽  
Zeenat Fatima ◽  
Swati Sharma ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Clinical Predictors ◽  
Antidiabetic Therapy ◽  
Adherence To Medication

Abstract Objectives The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). Methods This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients’ prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. Results A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA’s and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. Conclusions Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.

scholarly journals Implementation and Evaluation of a Team-Based Approach to Hospital Discharge Transition of Care

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Matthew Van De Graaf ◽  
Hemal Patel ◽  
Brynn Sheehan ◽  
Jennifer Ryal
Keyword(s):  
Hospital Discharge ◽  
Transitional Care ◽  
Data Extraction ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Phone Call ◽  
Readmission Rates ◽  
The Cost ◽  
Discharge Transition

Background: Transitional care management (TCM) programs guide patients from hospital discharge to outpatient follow-up with the goal to decrease hospital readmissions and the cost of care. In 2017, the department of primary care internal medicine (PCIM) at Eastern Virginia Medical Group implemented TCM. We aimed to evaluate the efficacy and self-sustainability of this TCM program. Methods: The TCM team contacted patients upon discharge to schedule the follow-up appointment. We coded patient contact as (1) no successful phone-call contact, patient did not attend appointment; (2) successful phone-call contact, patient did not attend appointment; and (3) patient attended appointment. We collected patient demographics, readmissions, and visit costs using manual chart review and electronic health record (EHR) data extraction. We conducted χ2 analysis, one-way analysis of variance, and unpaired t tests to assess associations between readmission rates or costs and TCM care. Results: Initial analysis did not indicate significant associations between readmission rates and level of TCM care at 30 (χ2=1.40, P=.50), 60 (χ2=5.48, P=.06), or 90 (χ2=4.23, P=.12) days or significant differences in patient charges at 30 (F[2,59]=2.85, P=.06), 60 (F[2,91]=2.00, P=.14), or 90 (F[2,126]=1.39, P=.25) days. Follow-up analysis indicated significant associations between readmission rates and any level of TCM care at 60 (χ2=5.40, P=.02) and 90 (χ2=4.21, P=.04) days, but not at 30 days (χ2=1.39, P=.28). Conclusions: Our TCM program review suggests that the benefits of transitional care extend beyond 30 days by decreasing readmission rates at 60 and 90 days after hospital discharge.

scholarly journals The Effectiveness of Telephone Intervention for Improving Patient Adherence to Medication among Diabetic Patients: A Systematic Review and Meta-analysis of Randomized Trials

2021 ◽  
Author(s):  
Debbie P. Monterona ◽  
Rhoda Alfonsa Matinong ◽  
Jeriel Reyes De Silos
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Patient Adherence ◽  
Text Message ◽  
Phone Call ◽  
Cochrane Library ◽  
Diabetic Patients ◽  
Telephone Intervention ◽  
Services Research ◽  
Adherence To Medication

Introduction: Diabetes is one of the chronic diseases that requires adherence to prescribed medications. With the current pandemic, mobile technology plays a role in caring for patients remotely. Objective: To determine the effectiveness of telephone intervention (phone call and text message) on medication adherence among diabetic patients. Methodology: Randomized controlled trials were searched in Cochrane Library, PubMed, Herdin, BMC Health Services Research using combination of terms through boolean operators (phone message OR phone call) AND (medication adherence AND diabetes) which compared telephone intervention vs usual care. mean, sample size and standard deviation of Medication Adherence in each study were extracted. Review Manager 5.4 software was used for statistical analysis. Results: Three trials met the inclusion criteria and were included in this study. The telephone intervention did not result in statistically significant improvement in medication adherence among diabetics (pooled mean difference: 0.05 95%CI -.08 to 0.17) Conclusion: The intervention was no more effective than the usual care. However, mobile use has potential application for remote care during this pandemic.

scholarly journals Transition of Care for Young Adult Survivors of Childhood and Adolescent Cancer: Rationale and Approaches

2010 ◽  
Vol 28 (32) ◽  
pp. 4810-4818 ◽  
Author(s):  
David R. Freyer
Keyword(s):  
Young Adult ◽  
Transitional Care ◽  
Adult Survivors ◽  
The United States ◽  
Transition Of Care ◽  
Medical Needs ◽  
Adolescent Cancer ◽  
Services Delivery ◽  
Young Adult Survivors

Purpose Young adult survivors of childhood and adolescent cancer are an ever-growing population of patients, many of whom remain at lifelong risk for potentially serious complications of their cancer therapy. Yet research shows that many of these older survivors have deficient health-related knowledge and are not engaging in recommended health promotion and screening practices that could improve their long-term outcomes. The purpose of this review is to address these disparities by discussing how formal transition of care from pediatric to adult-focused survivorship services may help meet the unique medical, developmental, and psychosocial challenges of these young adults. Design Literature review and discussion. Results This article summarizes current research documenting the medical needs of young adult survivors, their suboptimal compliance with recommended follow-up, and the rationale, essential functions, current models, and innovative approaches for transition of follow-up care. Conclusion Systematic health care transition constitutes the standard of care for young adult survivors of childhood cancer. In developing a transitional care program, it is necessary to consider the scope of services to be provided, available resources, and other local exigencies that help determine the optimal model for use. Additional research is needed to improve health services delivery to this population. Effective advocacy is needed, particularly in the United States, to ensure the availability of uninterrupted health insurance coverage for survivorship services in young adulthood.

scholarly journals Pharmacist-Led Discharge Medication Counseling and its Corresponding Impact on Medication Adherence and Hospital Readmission Rates

2020 ◽  
Vol 11 (3) ◽  
pp. 6
Author(s):  
Savannah Cunningham ◽  
Joshua D. Kinsey
Keyword(s):  
Medication Adherence ◽  
Hospital Readmission ◽  
Intervention Group ◽  
Control Group ◽  
Readmission Rates ◽  
Discharge Medication ◽  
Hospital Readmission Rates ◽  
Medication Counseling ◽  
Significant Difference

Objectives: Pharmacists have been shown to reduce hospital readmission rates and improve adherence rates by providing discharge medication counseling and offering services such as a bedside delivery program.1 Hospitals are now penalized by Medicare if patients are readmitted within 30 days of discharge, so implementation of these programs have the potential to be financially significant as well.2 The primary endpoint of this study is to evaluate the impact of a pharmacist discharge medication counseling bedside delivery program on medication adherence rates within a six-week period following discharge. The secondary endpoint focuses on hospital readmission rates. The objective of this study is to increase collaboration between community pharmacies and hospitals in order to improve the quality of patient care. Methods: This study was designed as intervention versus control, whereas the intervention patients were those who received counseling from a pharmacist or pharmacist intern and control patients were those who did not within the same time period. Collected patient data (n=81) included patients’ demographic data and all disease states, genders, and insurance coverage were encompassed by the included patients. Medication adherence was measured at follow-up intervals utilizing the proportion of days covered (PDC) equation, where a score of at least 80% is required for optimal therapeutic efficacy. Informed consent was obtained from all participants regarding a follow-up telephone call or retrieval of medication records through the pharmacy electronic medication records system and hospital electronic medical records system. Approximately 10-15-minute counseling sessions were performed at the time of discharge. Follow-up phone calls were conducted for the intervention group at four-weeks and six-weeks post-discharge using an eight-item Morisky medication adherence survey to discuss medication adherence and side effects experienced.  Results: There was a total of 81 patients enrolled in this study. There were 27 patients in the intervention group and 54 patients in the control group. These pharmacist-led discharge counseling sessions made a statistically significant difference in medication adherence rates (P=<0.001) as calculated using PDC, showing adherence rates of 84.4% in the intervention group and 62.8% in the control group. The pharmacist-led discharge counseling sessions did not make a statistically significant difference in hospital readmission rates, though investigators do expect to see an impact on clinical and financial endpoints. Conclusion: Pharmacist involvement in a bedside delivery program helps to improve medication adherence in patients being discharged from a hospital. A PDC of at least 80% is required for optimal therapeutic efficacy in most classes of chronic medications, and only the intervention arm reached this threshold.13 Although this study’s sample size was not sufficient to show a statistically significant difference in reduced hospital readmission rates for patients receiving a pharmacist-led discharge counseling session, the findings show the potential for a clinical impact and improved patient outcomes due to increased adherence rates.   Original Research

scholarly journals Impact of a Collaborative Pharmaceutical Care Service for Patients With Parkinson’s Disease

2022 ◽  
Vol 12 ◽  
Author(s):  
Zhan-Miao Yi ◽  
Sarah Willis ◽  
Yuan Zhang ◽  
Na Liu ◽  
Qi-Yu Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Patient Education ◽  
Care Service ◽  
Bodily Pain ◽  
Standard Of Care ◽  
Adherence Score ◽  
Pain Subscale ◽  
Patient Reported ◽  
The Impact

Objective: To identify the impact of a collaborative pharmaceutical care service (CPCS) on medication safety and establish the impact of the CPCS on patient reported outcomes for Parkinson’s disease (PD) patients.Methods: Initially, PD outpatients receiving the CPCS between March 2017 and March 2019 were compared with PD patients receiving standard of care to identify differences in management. Pharmacist interventions data were coded and patients with PD receiving the CPCS were compared with those receiving standard of care to determine differences in medicines prescribed and dosage associated with these. Following this, data of patients receiving CPCS at baseline and 3-months follow-up were collected using a questionnaire consisting of validated measures of two patient-reported outcomes [adherence and quality of life (QoL)]. Mean scores for continuous variables were calculated, with descriptive analysis of categorical variables consisting of frequency counts and percentages. Change in adherence score before and after CPCS was investigated using a Wilcoxon sign rank sum test, spearman correlation analysis was used to correlate the changes in QoL before and after CPCS with the number of interventions, and p &lt; 0.05 indicates that the difference is statistically significant.Results: A total of 331 PD outpatients received CPCS over 490 outpatient visits with an average age of 71.83 (±12.54). Five hundred and forty-five drug related problems were recorded as pharmacist interventions, of which most involved change to dosage (n = 226, 41.47%), adverse drug reactions (n = 135, 24.77%), and change in a medication (n = 102, 18.72%). Compared with those receiving standard of care, patients receiving CPCS were significantly less likely to have been prescribed pramipexole (18.52 versus 23.77%, p &lt; 0.001) and more likely to have been prescribed amantadine (5.40 versus 3.70%, p = 0.02) and selegiline (17.36 versus 11.64%, p &lt; 0.001). Lower dosages of levodopa/benserazide (0.51 ± 0.31 g versus 0.84 ± 0.37 g, p &lt; 0.001), levodopa/carbidopa (0.33 ± 0.23 g versus 0.66 ± 0.47 g, p &lt; 0.001), pramipexole (1.14 ± 1.63 mg versus 1.27 ± 0.69 mg, p = 0.01), and entacapone (130.00 ± 79.76 mg versus 173.09 ± 97.86 mg, p &lt; 0.001) were also recorded. At baseline 119 PD outpatients with an average age of 69.98 (±9.90) were recruited for the longitudinal study. At 3-month follow-up, participants reported improvement in bodily pain subscale (baseline versus 3-months follow-up, 30.04 ± 22.21 versus 23.01 ± 20.98, p = 0.037) and medication adherence (6.19 ± 1.50 versus 6.72 ± 1.73, p = 0.014). Frequency of CPCS use was related to activity of daily living subscale (p = 0.047), the bodily pain subscale (p = 0.026), and medication adherence (p = 0.011). Total score of PDQ-39 was associated with patient education (p = 0.005) and usage and dosage combined with patient education (p = 0.006), while medication adherence score was associated with usage and dosage (p = 0.005).Conclusion: The CPCS was effective in resolving drug-related problems and in improving patients’ medication regimens, medication adherence, and QoL through patient education and dosage adjustments. This is the first step in the development and feasibility testing of pharmacy services for PD patients in China.

Preliminary Feasibility of a Peer-supported Diabetes Medication Adherence Intervention for African Americans

2019 ◽  
Vol 6 (6) ◽  
pp. 558-569 ◽  
Author(s):  
Olayinka O. Shiyanbola ◽  
Adati Tarfa ◽  
Ariana Song ◽  
Lisa K. Sharp ◽  
Earlise Ward
Keyword(s):  
Medication Adherence ◽  
African Americans ◽  
Self Efficacy ◽  
Diabetes Management ◽  
Management Strategies ◽  
Phone Call ◽  
Diabetes Medication ◽  
Support Mechanism ◽  
Culturally Informed

Objectives: African Americans (AAs) have higher rates of medication nonadherence compared to non-Hispanic whites. In this study, we determined the preliminary feasibility of an 8-week intervention focused on improving culturally-informed illness and medication beliefs, self-efficacy, and medication adherence. Methods: We used purposeful sampling to recruit 8 peer ambassadors (PAs), individuals constituting the advisory board of AAs adherent to their medicines, and 7 peer buddies (PBs), assessed as non-adherent to their diabetes medicines. PAs and PBs were paired. They completed 2 group educational sessions together and one follow-up phone call to PBs by PAs. Results: PAs were mostly female (N = 5, 63%), mean age of 55 years (± 8.3). Similarly, PBs were mostly female (N = 6, 86%), mean age of 56 years (± 6.3). Follow-up interviews with PBs revealed that they liked discussing medication management strategies and diabetes management resources, sharing their diabetes experiences with their PA and connecting with them over the phone. All PBs reported a positive, trusting relationship between them and their PAs. Conclusions: This study demonstrates AAs with diabetes medication adherence challenges are receptive to a peer support mechanism to address culturally informed beliefs and enhance patient-provider communication and self-efficacy.

scholarly journals Adherence to medication in the community: Audit cycle of interventions to improve the assessment of adherence

2017 ◽  
Vol 41 (1) ◽  
pp. 41-44
Author(s):  
Saeed Farooq ◽  
Abid Choudry
Keyword(s):  
Medication Adherence ◽  
Text Messaging ◽  
Clinical Implications ◽  
Clinical Notes ◽  
Medication Side Effects ◽  
Adherence To Medication ◽  
Retrospective Audit ◽  
Medication Side ◽  
Regular Training

Aims and methodTo investigate whether medication adherence is monitored during follow-up in out-patient reviews. A retrospective audit was carried out with a sample of 50 follow-up patients with a diagnosis of schizophrenia or schizoaffective disorder. Following this, interventions were made prior to the re-audit (including text messaging clinicians and prompt sheets in the out-patient department to encourage adherence discussions).ResultsThere was an improvement on all the standards set for this audit following the interventions. More doctors had discussed medication adherence (62% second cycle v. 50% first cycle) with their patient and there was increased discussion and documentation regarding medication side-effects (60% second cycle v. 30% first cycle). More clinicians discussed the response to medication (60% second cycle v. 46% first cycle).Clinical implicationsTreatment adherence is not regularly monitored or recorded in clinical notes in routine psychiatric out-patient appointments. This highlights the need for regular training to improve practice.

Diabetes Transitional Care from Inpatient to Outpatient Setting

2012 ◽  
Vol 26 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Mansi Shah ◽  
CaTanya A. Norwood ◽  
Sol Farias ◽  
Sonia Ibrahim ◽  
Pang H. Chong ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Transitional Care ◽  
Intervention Group ◽  
Outpatient Setting ◽  
Controlled Study ◽  
Adherence Rate ◽  
Control Group ◽  
Diabetes Medication ◽  
Counseling Intervention

Purpose: Diabetes transitional care from the inpatient to outpatient setting is understudied. This study evaluated the effect of inpatient pharmacist discharge counseling on outpatient diabetes medication adherence. Research methods: Prospective, randomized, controlled study compared pharmacist discharge counseling (intervention) with usual patient care (control) in 127 patients with established diabetes and an A1C ≥8% who had a provider and medications filled within the county health system. The primary outcome was diabetes medication adherence rate measured using the prescription of days covered (PDC) method. Results: Patients in the intervention, compared with control group, had greater diabetes medication adherence rate 150 days after discharge (55.2% vs 34.8%; P = .002), rate of follow-up visits (60.5% vs 43.9%; P = .01) and reduction in A1C (−1.97% vs +0.114%; P = .003). Being in the intervention group and having greater adherence with follow-up visits correlated independently with lower follow-up A1C. Conclusion: Transitional care in the form of inpatient education geared to improve self-management after hospital discharge. This may serve as a paradigm to improve outpatient adherence rate with medications, follow-up visits, and A1C reduction.

scholarly journals Patient Adherence to Medication within a New Multidisciplinary Thrombosis Service

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 38-38
Author(s):  
Kwadwo Osei Bonsu ◽  
Stephanie W Young ◽  
Tiffany Lee ◽  
Hai V Nguyen ◽  
Rufaro S Chitsike
Keyword(s):  
Patient Satisfaction ◽  
Secondary Education ◽  
Medication Adherence ◽  
Research Funding ◽  
Post Secondary Education ◽  
Anticoagulation Management ◽  
Post Secondary ◽  
Adherence To Medication ◽  
The Impact

BACKGROUND Poor medication adherence puts patients who require thrombosis care at greater risk of complications. Little is known about the impact of multidisciplinary care models on medication adherence in patients requiring anticoagulation management. It is also unclear from the literature whether adherence varies in clinical practice with the advent of direct oral anticoagulants (DOACs) which have shorter half-lives and require limited or no laboratory monitoring compared to vitamin-K antagonists. We started a new multidisciplinary Adult Outpatient Thrombosis Service (TS) in October 2017 in a Canadian health authority servicing over 300 000 people. The TS is a comprehensive thrombosis and anticoagulation management program with unique, interrelated clinics providing the spectrum of care required for this patient group. The TS includes an Emergency Thrombosis Clinic for care after an acute episode of venous thromboembolism; Thrombosis Clinics addressing non-urgent thrombosis and anticoagulation questions and follow up; Anticoagulation Management Clinics for long term follow up of patients on anticoagulation; and a Perioperative Anticoagulation Management Clinic for patients on anticoagulation requiring surgery or procedures. The TS is staffed by Pharmacists, a Thrombosis Physician/Hematologist, and Clerical staff. The objective of the survey was to assess self-reported medication adherence of patients within the TS. PATIENTS/METHODS We conducted a cross-sectional survey of patients who were consulted to the TS between October 2017 and May 2019. Eligible patients were mailed an anonymous survey with a cover letter and self-addressed, return stamped envelope. Adherence to medication was assessed using the 12-item validated Adherence to Refills and Medications Scale (ARMS). The ARMS utilizes a 4 point scale (1-4), with the continuous score range of 12 to 48, and lower scores indicating better adherence. Baseline characteristics and patient satisfaction with the TS were evaluated for association with medication adherence. Linear regression analysis was used to examine the associations between patient's characteristics, their satisfaction with TS and medication adherence. RESULTS Of 1058 eligible patients, 563 responded to the survey representing a response rate of 53%. Seventeen were excluded who had more than 6 missing responses to the ARMS items. Out of remaining 546 patients with complete responses 55% (n=297) were on DOACs, 19% (n=102) on warfarin, 5.0% (n=27) on low molecular weight heparin (LMWH), 3.3% (n=18) on antiplatelet therapy and 18% (n=96) were not receiving anticoagulation therapy at the time of completing the survey. Nearly half had taken anticoagulant for 1 to 5 years (47%, n=253) while 28% (n=150) and 25% (n=137) had been on an anticoagulant for less than 1 year and more than 5 years respectively. Most patients (87%, n=475) were 50 years of age or older and half (51%, n=277) were male. About two-thirds (67%, n=360) had at least post-secondary education. The mean score for the ARMS was 13.9 (SD 2.2, range 12 to 25). Most patients (88%, n = 481) reported high adherence to medication (ARMS score = 12-16). In univariate analysis, post-secondary education (β = 0.0052, p = 0.006) and patient satisfaction with the TS (β = 0.0004; p = 0.019) significantly predicted medication adherence among participants. In multivariate analyses education (β = 0.0039, p = 0.048) and duration of anticoagulant use (β = 0.0047, p = 0.0244) were significantly associated with medication adherence. The internal consistency reliability for the ARMS tool was acceptable (Cronbach's alpha = 0.70). CONCLUSIONS Self-reported medication adherence was high (88%) in patients seen at a multidisciplinary TS. Post-secondary education and duration of anticoagulant use were important predictors of medication adherence. Disclosures Young: Sanofi Canada: Honoraria, Research Funding; Bayer: Research Funding; Pfizer: Honoraria. Chitsike:Bayer Canada: Research Funding; Sanofi Canada: Honoraria, Research Funding.

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