Search

Background Discharge and transfer between healthcare facilities put older adults at risk of medication-related problems and early readmission. This review examined the evidence for pharmacist interventions at discharge and patients’ care quality. Methods Eight databases were searched systematically from inception to date, using the appropriate search strategy for each. A search for grey literature was conducted on eight further websites. No filters (e.g. language/dates) were applied. Only prospective randomized/quasi-randomized controlled studies involving patients > 65 years of both genders, discharged alive from hospital, were included. The criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions formed the basis of the assessment, conducted using RevMan 5.3. Results 9738 articles were obtained: 8120 unique articles after duplicate removal. Following screening, 12 studies were identified for inclusion. Interventions comprised follow up, medication review and patient counselling at discharge. Of these, 10 were delivered by pharmacists alone, while the remainder were delivered by pharmacists within a multidisciplinary team. Outcome measures included readmission rates, length of stay, medication adherence and care quality. Nine studies showed significant improvements over standard care, e.g. a decrease in hospital admissions (0.68 OR, p=0.002), improved compliance (P However, three studies did not report positive results: Two reported non-significant improvement but the third reported poorer readmission rates. Risk of bias was low but the high baseline standard of care reduced the scope for improvement in two of these studies. Conclusion The review summarizes pharmacist interventions’ efficacy and their effect on care quality indicators where possible. The majority of interventions at discharge significantly enhanced patients’ care quality. The findings should prove valuable to decision-makers when planning or improving discharge and post-discharge services.

Background This study assessed the pharmacist role in an 80 bed residential care unit by: Quantifying the number and type of pharmacist interventions made and their acceptance rate.Assessing impact of pharmacist interventions on patient care.Assessing staff attitudes towards the clinical pharmacist service. Methods This was a non-blinded, non-comparative evaluation of the existing clinical pharmacist service in the unit. All residents were included. All pharmacist interventions over a 10-week period were recorded, then graded according to the Eadon scale1 by a consultant gerontologist and an experienced pharmacist to assess their impact on patient care. Results There were 615 pharmacist interventions. The most common interventions were: Drug Therapy Review, 34% (n=209) Technical Prescription, 26.5% (n=163) Administration, 15.3% (n=94) Drug Interaction, 10.4% (n=64) Medication Reconciliation, 8.5% (n=52) 98% (n=596) of interventions were rated as having significance to patient care, of which: 48.4% (n=298) and 41.8% (n=257) of the interventions rated as ‘significant and resulting in an improvement in the standard of care’1% (n=6) and 0.5% (n=3) rated as ‘very significant and preventing harm’. There was a statistically significant agreement between the evaluators, κw = 0.231 (95% CI, 0.156 to 0.307), p < .0005. The strength of agreement was fair. Of interventions requiring acceptance by medical team (n=335), 89.9% (n=301) were accepted. 95% (n=36) of staff who responded agreed or strongly agreed that improved patient safety resulted from the pharmacist’s involvement in multidisciplinary medication reviews. Over 92% (n=35) agreed or strongly agreed that their experience of the pharmacist was positive. Conclusion The pharmacist has an important role in our residential care unit. Their involvement in the medicines optimisation process positively impacts patient outcomes and prevents harm. Staff perceived a positive impact of the clinical pharmacist service provided on patient care and patient safety.

Background In Parkinson’s Disease (PD) medication adherence has been neglected. Despite evidence of successful interventions in other chronic diseases, there is currently no review of medication adherence enhancing interventions in PD populations. This review sought to identify and evaluate interventions to improve medication adherence in patients with PD. Methods Six online databases (PubMed, EMBASE, Medline, PsycINFO, CinahlCOMPLETE, AMED) were searched. Key concepts “Medication adherence” and “Parkinson’s disease” were used. Reference lists of retrieved studies were hand searched. Studies were assessed for inclusion against pre-specified eligibility criteria. Data extraction was carried out using a standardised data extraction table. Critical appraisal was undertaken using the JADAD score, CASP Randomised Controlled Trial (RCT) checklist, “Quality Assessment tool for before-after studies with no control group” and the TREND statement checklist. Results The search resulted in 612 records of which five met inclusion criteria (3 RCT, 2 before-after studies). A total of 496 PD patients were included. Interventional strategies investigated were educational intervention, adherence therapy, effect of a Parkinson’s Tracker App (PTA) and intervention by a pharmacist. Five (100%) of the studies included in this review reported a statistically significant improvement in medication adherence post-intervention and some improvements in symptoms. Conclusion This is the first review of medication adherence in the PD population. Several different interventions proved effective in enhancing medication adherence, but the studies were small, short term and the risk of bias ranged from moderate to high. Consequently, the results may not be generalisable to other PD populations.