Search

Background: Transitions of care (TOC) is one of three key action areas identified in the World Health Organization (WHO)'s third Global Patient Safety Challenge, Medication Without Harm, released in 2017. Systematic reviews have shown that TOC interventions can improve health outcomes, although few studies have evaluated the role of the community pharmacist., Objective: To evaluate the feasibility of a pharmacist-led TOC intervention for older adults at risk of drug-related problems., Methods: Pragmatic feasibility study conducted in hospital and community pharmacies in a health region of Quebec, Canada. The interventions consisted of a pharmaceutical care plan developed by the hospital pharmacist and transferred at hospital discharge to the patients' community pharmacist, who completed patient consultations in the week following discharge and monthly for six months thereafter. Feasibility evaluations included recruitment, retention, time required, types of interventions, and modified classes of medications, based on clinical data entered in an electronic health record accessible to clinicians in all settings., Results: Of the 90 recruited patients, 76 were discharged with a pharmaceutical care plan. The mean age of these 76 subjects was 79.5 years, and 52.6% were female. The most frequent inclusion criteria were 15 or more medications (57.9%), two or more emergency department visits (past three months), or one or more hospitalization (past twelve months) (42.1%). The hospital pharmacist interventions took a mean time of 222 min. The community pharmacist interventions took a mean time of 52 min and 32 min for the first and subsequent visits, respectively. Therapeutic goals were documented for 60.5% of patients., Conclusions: This study shows the feasibility of implementing a pharmacist-led TOC intervention in the Canadian context. Development of the TOC model in three health regions is currently being pursued along with the inclusion of primary care clinics who recently added pharmacists to their interdisciplinary teams., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Patients in long-term care institutions (LTCI) are especially at risk for osteoporotic fractures owing to their lack of mobility, poor nutrition, and limited sun exposure. Previous reports have shown that osteoporosis is underdiagnosed and undertreated in LTCI despite the high incidence of osteoporotic fractures in these settings. This document has been developed to assist clinicians practicing in LTCI with the diagnosis and treatment of osteoporosis in their institutionalized patients. These proceedings offer an overview of the particular characteristics of patients at LTCI. Management strategies include both nonpharmacological and pharmacological interventions for the prevention and treatment of osteoporotic fractures in very frail older subjects., Participants: This guide is an edited review of presentations and discussions held by specialists in osteoporosis in the elderly together with physicians and pharmacists practicing in LTCI in the province of Quebec. This symposium was held in Saint-Hyacinthe, Quebec on November 5, 2004., Values: The value of a given diagnostic test or treatment option was determined based on the clinical experiences and opinions of the participants and a review of the literature from an evidence-based perspective., Recommendations: All patients located at LTCI are at potential risk for osteoporotic fractures. Global interventions should include vitamin D, calcium, and a comprehensive exercise program. In patients who are at high risk for osteoporotic fractures or with previous fractures, pharmacological treatment should be started., Validation: These recommendations were approved during the final plenary of the symposium. All the prevailing opinions were summarized and included in this article.