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BackgroundThe transition between inpatient and outpatient care for hospitalized people with HIV represents an opportunity for linkage and re-engagement in care. We evaluated whether attendance at a post-hospitalization visit ('discharge clinic') within 1-2 weeks of discharge would reduce readmissions and improve retention in care (RIC) among people with HIV in San Diego, California, USA.MethodsThis was a retrospective cohort study of people with HIV hospitalized between June 2020 and November 2021. Our primary outcome was 30-day readmissions among people with HIV who did or did not attend a discharge clinic visit. Secondary outcomes included the effect of discharge clinic attendance on RIC, along with the impact of attendance at any HIV clinic visit within 30 days of discharge on readmissions and RIC.ResultsWe evaluated 114 people with HIV, of whom 77 (67.5%) and 90 (78.9%) attended a discharge clinic visit or any HIV clinic visit within 30 days of discharge, respectively. Active substance use disorder (SUD) was associated with failing to attend a discharge clinic visit (odds ratio 0.31; 95% confidence interval 0.13-0.77). We observed no significant differences in readmissions between people with HIV who did or did not attend a discharge clinic visit; however, the former had significantly higher 6-month RIC (79.2% vs. 35.1%, p

Purpose: Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. Methods: We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. Results: Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). Conclusions: Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. Implications for Cancer Survivors: Tailored supportive resources are needed for caregivers throughout survivorship transitions. [ABSTRACT FROM AUTHOR]

Background: The purpose of this qualitative study was to identify emergent rehabilitation innovations and clinician perceptions influencing their implementation and outcomes related to hospital discharge decision-making during the Coronavirus 2019 pandemic. Methods: Rehabilitation clinicians were recruited from the Veterans Affairs Health Care System and participated in individual semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Data were analyzed using a rapid qualitative, deductive team-based approach informed by directed content analysis. Results: Twenty-three rehabilitation clinicians representing physical (N = 11) and occupational therapy (N = 12) participated in the study. Three primary themes were generated: (1) Innovation: emerging innovations in discharge processes included perceived increases in team collaboration, shifts in caseload prioritization, and alternative options for post-acute care. (2) Recipients: innovations emerged as approaches to communicating discharge recommendations changed (in-person to virtual) and strong patient/family preferences to discharge to the home challenged collaborative goal setting; and (3) Context: the ability of rehabilitation clinicians to innovate and the form of innovations were influenced by the broader hospital system, interdisciplinary team dynamics, and policy fluctuations. Innovations described by participants included (1) use of technological modalities for interdisciplinary collaboration, (2) expansion of telehealth modalities to deliver care in the home, (3) changes in acute care case prioritization, and (4) alternative options for discharge directly to home. Conclusions: Our findings reinforce that rehabilitation clinicians developed innovative strategies to quickly adapt to multiple systems-level factors that were changing in the face of the COVID-19 pandemic. Future research is needed to assess the impact of innovations, remediate unintended consequences, and evaluate the implementation of promising innovations to respond to emerging healthcare delivery needs more rapidly. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Background Design Method Results Conclusions To explore the experiences and perceptions of communication about managing medication across transitions of care for residents living in aged care homes and their family caregivers.Effective medication communication across transitions of care involves exchanging information, resident, and family caregiver's participation in decision‐making, and shared responsibility.A qualitative meta‐synthesis.This review was conducted in accordance with the PRISMA 2020 guidelines and the accompanying 27‐item checklist. A systematic search of seven electronic databases (Embase, PsycINFO, Medline Ovid, Scopus, CINAHL, EmCare and Web of Science) was performed from inception to December 2023. Studies eligible for inclusion in this review were required to be published in peer‐reviewed English journals and focus on medication communication among healthcare providers, residents and family caregivers during transitions of care for aged care residents. The JBI Critical Appraisal Checklist for Qualitative Research was employed for the critical appraisal of the studies, and the COREQ checklist was used to evaluate their quality.Of the 2610 studies identified, 12 met the inclusion criteria. No study was excluded based on quality. Two main themes were generated: (1) Medication information exchange involving residents and families, and (2) resident and family factors influencing medication communication engagement. The findings revealed a lack of supportive structure for effective communication and collaboration among residents, family caregivers and healthcare providers during transitions of care, marked by one‐way interactions and limited evidence of shared decision‐making or family caregiver engagement in medication management communication, despite varying individual needs and preferences.Communication about medication management during transitions of care focused on sharing details rather than active engagement. Residents and their family caregivers have individual needs and perspectives regarding communication about medication management, which are not well addressed by healthcare providers during transitions of care. Healthcare providers' communication remains limited, and family caregivers are underutilised. [ABSTRACT FROM AUTHOR]

Background and Aims: Potentially harmful polypharmacy is a growing public health concern. This article aims to evaluate the effectiveness of a structured Team Approach to Polypharmacy Evaluation and Reduction (AusTAPER) framework. Methods: We recruited patients at metropolitan hospitals for a randomised controlled trial with 12 months of follow‐up. The intervention included a comprehensive medicines history, multidisciplinary meeting and medicines review prior to discharge, with engagement with the participants' general practitioner extending after discharge. The primary outcome was the change in the number of regular medicines used at 12 months from baseline. A cost consequence was performed to estimate costs per participant during the study period. Results: There were 98 participants enrolled in the study. The number of regular medicines was significantly reduced from baseline in both groups (−1.7 ± 4.3, t = 2.38, P = 0.02 in the control group vs −2.7 ± 3.6, t = 4.48, P = 0.0001 in the intervention group), although there was no statistical difference detected between the two groups (1.0 (SE 0.9), t = 1.03, P = 0.31). The intervention was estimated to cost AU$644.17 and was associated with cost savings of AU$552.53 per participant in sustained reduced medicines cost. Health outcomes and healthcare costs were similar in both groups. Discussion: Medicines were significantly reduced in both groups, with a trend to a larger reduction in medicines at 12 months in the intervention group. The intervention cost was approximately offset by sustained reduced medicines cost, although these results should be regarded cautiously because of the absence of significance in the differences in outcomes between groups. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aims Methods Results Conclusions Timely transition of care amongst patients with a first diagnosis of cirrhosis in a hospital to an outpatient visit is important. We evaluated rates of outpatient follow‐up after a first diagnosis of cirrhosis during an inpatient setting, and its association with subsequent rates of rehospitalisation and mortality.We conducted a population‐based cohort study identifying all hospitalised patients in Sweden diagnosed with cirrhosis between 2002 and 2020 from the Swedish National Patient Register. The primary outcome was any outpatient visit related to cirrhosis within 90 days after hospital discharge. Secondary outcomes were rates of rehospitalisation and mortality within 1 year of discharge in patients receiving outpatient follow‐up within 90 days or not. Cox regression was used for all analyses, and incidence rates per 1000 person‐years were calculated for mortality and rehospitalisation.Of 8852 patients, 3759 (42%) had outpatient follow‐up within 90 days of discharge. Patients who received follow‐up within 90 days of discharge were younger, had a higher level of education and were more likely to have liver decompensation or hepatocellular carcinoma compared to those without timely follow‐up. We found that follow‐up within 90 days was associated with lower rates of all‐cause mortality within 1 year (aHR = 0.86, 95%CI = 0.78–0.96) but with no significant impact on rehospitalisations (aHR = 0.97, 95%CI = 0.91–1.03).In Sweden, 42% of hospitalised patients with newly diagnosed cirrhosis receive outpatient follow‐up within 90 days of their hospital discharge. These patients may experience lower mortality but no change in rehospitalisations within 1 year. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this qualitative study was to identify emergent rehabilitation innovations and clinician perceptions influencing their implementation and outcomes related to hospital discharge decision-making during the Coronavirus 2019 pandemic. Methods Rehabilitation clinicians were recruited from the Veterans Affairs Health Care System and participated in individual semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Data were analyzed using a rapid qualitative, deductive team-based approach informed by directed content analysis. Results Twenty-three rehabilitation clinicians representing physical (N = 11) and occupational therapy (N = 12) participated in the study. Three primary themes were generated: (1) Innovation: emerging innovations in discharge processes included perceived increases in team collaboration, shifts in caseload prioritization, and alternative options for post-acute care. (2) Recipients: innovations emerged as approaches to communicating discharge recommendations changed (in-person to virtual) and strong patient/family preferences to discharge to the home challenged collaborative goal setting; and (3) Context: the ability of rehabilitation clinicians to innovate and the form of innovations were influenced by the broader hospital system, interdisciplinary team dynamics, and policy fluctuations. Innovations described by participants included (1) use of technological modalities for interdisciplinary collaboration, (2) expansion of telehealth modalities to deliver care in the home, (3) changes in acute care case prioritization, and (4) alternative options for discharge directly to home. Conclusions Our findings reinforce that rehabilitation clinicians developed innovative strategies to quickly adapt to multiple systems-level factors that were changing in the face of the COVID-19 pandemic. Future research is needed to assess the impact of innovations, remediate unintended consequences, and evaluate the implementation of promising innovations to respond to emerging healthcare delivery needs more rapidly.

BackgroundSuccessful transitions of care require communication between inpatient and outpatient physicians. The discharge summary is the main communication tool used by physicians during these transitions.ObjectiveWith the goal of improving care transitions, we explored primary care physicians (PCPs) perspectives on characteristics of high-quality discharge summaries.DesignWe conducted semi-structured individual interviews in this qualitative study and surveyed participants for sociodemographic characteristics.ParticipantsPCPs were recruited from multiple health systems in California.ApproachAn interview guide was created by the study authors to solicit PCPs' experiences with discharge summaries and perspectives on four discharge summary templates previously used by large health systems. Interviews were transcribed verbatim and qualitative data were analyzed interactively through thematic analysis.Key resultsTwenty PCPs participated in interviews lasting an average of 35 min (range 26-47 min). Sixty percent were female. Most (70%) had trained in internal medicine (IM); 5% had trained in both IM and pediatrics and 25% in family medicine. Some (45%) participants practiced both inpatient and outpatient medicine; 55% had exclusively outpatient practices. Half worked in university-affiliated clinics, 15% community clinics, 15% public health clinics, 5% private practice, and 15% multiple clinic types. Many PCPs (65%) had been in practice for ≥ 10 years. Participants reported multiple concerns with typical discharge summaries, including frustration with lengthy documents containing information irrelevant to outpatient care. Suggested recommendations included beginning the discharge summary with action items, clear identification of incidental findings requiring follow-up, specifying reasons for any medication changes, and including dates for treatment regimens rather than expected duration of treatment. Participants highlighted the importance of feedback to trainees to assist in crafting succinct discharge summaries containing relevant information.ConclusionClinical training programs and healthcare systems must optimize discharge summaries for PCPs to achieve goals of providing high-quality care that improves population health.

Purpose: Unintentional medication discrepancies (UMD) are common amongst geriatric patients. If not addressed, these UMD can lead to suboptimal care and increased health care spending. Ambulatory care pharmacists are trained to identify and resolve UMD, and help tailor medication regimens to assure optimized and safe patient-centered care. The purpose of this retrospective study was to highlight the role of a remote, ambulatory care pharmacist in a geriatric primary care setting. Methods: This was a multicenter, single cohort, retrospective chart review of patients enrolled in a geriatric primary care initiative. Patients met with an ambulatory care pharmacist for a 60-minute telemedicine appointment. The primary endpoint was the percent of patients seen by the ambulatory care pharmacist with at least 1 medication discrepancy identified. Results: A total of 275 visits were scheduled with the ambulatory care pharmacist during the 6-month study period. At least 1 unintentional medication discrepancy (UMD) was identified in 151 patients (66%). At least 1 edit was made to the patient's medication list in 224 patients (97%). The ambulatory care pharmacist made recommendations to the provider in 210 patients (91%). The CPA was utilized in 75 patients (33%). Conclusion: This study highlights the utility of a remote, ambulatory care pharmacist in a geriatric primary care setting. Two-thirds of patients were noted to have at least 1 UMD, and more than 90% of patients were identified as having suboptimal regimens. This initiative shows the impact of a remote, ambulatory care pharmacist on patient care. [ABSTRACT FROM AUTHOR]

The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits which has been implemented at two hospitals in the United States. The objectives of this study were to: 1) explore perspectives surrounding the PHARM-DC program from healthcare providers, leaders, and administrators at both institutions, and 2) identify factors which may contribute to intervention success and sustainability. Focus groups and interviews were conducted with pharmacists, physicians, nurses, hospital leaders, and pharmacy administrators at two institutions in the Northeastern and Western United States. Interviews were audio recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Thematic analysis was performed using an iterative process, with two study authors independently coding transcripts to identify themes. Overall, 37 individuals participated in ten focus groups and seven interviews. The themes identified included: 1) Organizational, Pharmacist, and Patient Factors Contributing to Transitions of Care, 2) Medication Challenges in Transitions of Care at Admission and Discharge, 3) Transitions of Care Communication and Discharge Follow-up, and 4) Opportunities for Improvement and Sustainability. The four themes were mapped to the constructs of the CFIR and RE-AIM frameworks. Some factors facilitating intervention success and sustainability were accurate medication histories collected on admission, addressing medication barriers before discharge, coordinating discharge using electronic health record discharge features, and having a structured process for intervention training and delivery. Barriers to intervention implementation and sustainability included gaps in communication with other care team members, and variable pharmacist skills for delivering the intervention. This study identified that using educational resources to standardize the TOC process addressed the issue of variations in pharmacists' skills for delivering TOC interventions. Nurses, physicians, pharmacists, pharmacist leaders, and hospital administrators were in agreement regarding the usefulness of the PHARM-DC intervention, while acknowledging challenges in its implementation and opportunities for improvement. Future research should focus on developing training materials to standardize and scale the intervention, eliminating barriers to medication access pre-discharge, coordinating discharge across care team members, and communicating medication changes to primary care providers post-discharge. [ABSTRACT FROM AUTHOR]

The development and use of concentrated insulins have increased in recent years. This can pose unique challenges when transitioning to a non‐concentrated insulin during an inpatient admission. There is no clear consensus on the recommended interchange of the various concentrated insulins in the inpatient setting, with suggestions ranging from implementing a 1:1 unit dose conversion, a minimum 20% dose reduction or selecting an approach based on the total daily dose of the concentrated insulin. In a retrospective cohort analysis at a single health system, a greater number of hypoglycemic events occurred when implementing a 1:1 unit conversion of insulin glargine 300 units/mL (iGlar300) to insulin detemir 100 units/mL (iDet100) compared to the same conversion from insulin glargine 100 units/mL (iGlar100) to iDet100. This prompted identification of a standardized approach that would improve patient safety while also being operationally feasible at a multi‐hospital network. The solution of implementing a minimum 20% dose reduction successfully improved hypoglycemia rates upon transitioning from iGlar300 to iDet100, though many logistical challenges were faced. Although iDet100 is being phased off the market, adhering to this minimum 20% dose reduction is the recommended approach when transitioning from iGlar300 to iGlar100, and this challenge persists as a relevant issue. Ensuring health systems are equipped to implement dose reductions when transitioning from concentrated basal insulins to non‐concentrated basal insulin counterparts is paramount for maintaining patient safety. This paper will discuss the limited evidence available supporting optimal dosing when transitioning iGlar300 and insulin degludec 200 units/mL (iDeg200) to non‐concentrated basal insulins and serve as a "how to" implementation guide for other health systems, based on one health system's approach in navigating this emerging patient safety issue. [ABSTRACT FROM AUTHOR]

Youth-onset type 2 diabetes (T2D) is increasingly common and is often diagnosed shortly before transition from pediatric to adult care. Little is known about the experience of emerging adults (EAs) with T2D and the readiness, barriers, and facilitators to transition. This study sought to describe the illness experience of EAs with T2D and perceptions about transition, and explore themes by "transition readiness," measured by the Transition Readiness Assessment Questionnaire (TRAQ). In this mixed-methods study, we conducted semi-structured interviews with EAs with T2D using a guide grounded in the health belief model, administered the TRAQ, and collected disease metrics from the electronic medical record. We developed a coding scheme using a directed content-analysis approach and triangulated qualitative and quantitative data to compare themes stratified by mean TRAQ score. Participants described modifying factors like adjusting to life with a chronic illness and coping with mental health issues as critical elements of the illness experience that influence transition. Individual beliefs emerged including the perceived risk of disease complications being informed by experience of family members, self-efficacy in diabetes care hinging on the ability to be highly organized, and transition as a daunting obstacle with numerous emotional and logistical barriers. Participants emphasized the need for support from caregivers and providers throughout transition. Themes did not vary significantly by TRAQ score. Experiences of EAs with T2D suggest more assistance is needed in the transition period to address factors such as mental health, organizational skills, and identifying support people to facilitate care. [ABSTRACT FROM AUTHOR]

Abstract Objective Delayed transitions from pediatric to adult primary care leads to gaps in medical care. State all-payer claims data was used to assess multilevel factors associated with timely transition from pediatric to adult primary care. Materials and methods We created a cohort of 4,320 patients aged 17–20 in 2014–2017 continuously enrolled in health insurance 36 months between 2014 and 2019 and attributed to a pediatric provider in months 1–12. We also constructed primary care provider networks identifying links between providers who saw members of the same family. Logistic regression was used to predict adult primary care in months 25–36 on family, provider, and county-level factors. Finally, we modeled the effect of county and network cluster membership on care transitions. Results Male sex, having another family member seeing a pediatrician, and residing in a county with high pediatric care capacity or low adult primary care capacity were associated with lower odds of adult primary care transition. Discussion We investigated factors associated with successful transitions from pediatric to adult primary care. Family ties to a pediatrician and robust county capacity to provide primary care to children were associated with non-transition to adult primary care. Conclusion Multiple level factors contribute to non-transition to adult primary care. Understanding the factors associated with appropriate transition can help inform state and national policy.

Abstract Background As a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients’ multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program. Methods To ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher’s exact test for categorical variables, Student’s t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions. Discussion This study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions.

Objective: Delayed transitions from pediatric to adult primary care leads to gaps in medical care. State all-payer claims data was used to assess multilevel factors associated with timely transition from pediatric to adult primary care. Materials and methods: We created a cohort of 4,320 patients aged 17–20 in 2014–2017 continuously enrolled in health insurance 36 months between 2014 and 2019 and attributed to a pediatric provider in months 1–12. We also constructed primary care provider networks identifying links between providers who saw members of the same family. Logistic regression was used to predict adult primary care in months 25–36 on family, provider, and county-level factors. Finally, we modeled the effect of county and network cluster membership on care transitions. Results: Male sex, having another family member seeing a pediatrician, and residing in a county with high pediatric care capacity or low adult primary care capacity were associated with lower odds of adult primary care transition. Discussion: We investigated factors associated with successful transitions from pediatric to adult primary care. Family ties to a pediatrician and robust county capacity to provide primary care to children were associated with non-transition to adult primary care. Conclusion: Multiple level factors contribute to non-transition to adult primary care. Understanding the factors associated with appropriate transition can help inform state and national policy. [ABSTRACT FROM AUTHOR]

Background: Successful transitions of care require communication between inpatient and outpatient physicians. The discharge summary is the main communication tool used by physicians during these transitions. Objective: With the goal of improving care transitions, we explored primary care physicians (PCPs) perspectives on characteristics of high-quality discharge summaries. Design: We conducted semi-structured individual interviews in this qualitative study and surveyed participants for sociodemographic characteristics. Participants: PCPs were recruited from multiple health systems in California. Approach: An interview guide was created by the study authors to solicit PCPs' experiences with discharge summaries and perspectives on four discharge summary templates previously used by large health systems. Interviews were transcribed verbatim and qualitative data were analyzed interactively through thematic analysis. Key Results: Twenty PCPs participated in interviews lasting an average of 35 min (range 26–47 min). Sixty percent were female. Most (70%) had trained in internal medicine (IM); 5% had trained in both IM and pediatrics and 25% in family medicine. Some (45%) participants practiced both inpatient and outpatient medicine; 55% had exclusively outpatient practices. Half worked in university-affiliated clinics, 15% community clinics, 15% public health clinics, 5% private practice, and 15% multiple clinic types. Many PCPs (65%) had been in practice for ≥ 10 years. Participants reported multiple concerns with typical discharge summaries, including frustration with lengthy documents containing information irrelevant to outpatient care. Suggested recommendations included beginning the discharge summary with action items, clear identification of incidental findings requiring follow-up, specifying reasons for any medication changes, and including dates for treatment regimens rather than expected duration of treatment. Participants highlighted the importance of feedback to trainees to assist in crafting succinct discharge summaries containing relevant information. Conclusion: Clinical training programs and healthcare systems must optimize discharge summaries for PCPs to achieve goals of providing high-quality care that improves population health. [ABSTRACT FROM AUTHOR]

Background: Current data shows 30% of patients hospitalized for Chronic Obstructive Pulmonary Disease (COPD) exacerbation are readmitted within 30 days. Medication management during transitions of care (TOC) has shown impact on clinical outcomes, however there is insufficient data to suggest how pharmacy TOC services might benefit this patient population. Objective: Evaluate the effects of pharmacy-driven COPD TOC services on hospital re-presentation rates. Methods: A single-center retrospective chart review conducted of patients hospitalized for a COPD exacerbation. A comprehensive admission-to-discharge TOC service was provided by early immersion pharmacy students, advanced immersion pharmacy students, and an attending pharmacist in a layered learning model. The primary outcome was 30-day re-presentation rate. Secondary outcomes were 90-day re-presentation rate, volume of interventions made and description of the service. Results: From 1/1/2019 to 12/31/2019, there were 2422 patients admitted for COPD exacerbation management and 756 patients received at least one intervention from the COPD TOC service. 30% needed a change to inhaler therapy. The provider accepted 57.8% of the recommended changes, and 36% and 33% of eligible patients received an inhaler technique education and bedside delivery of the new inhaler, respectively. Outcomes in the 30-day re-presentation and 90-day censored re-presentation rates for the intervention and control group were 28.5% vs 25.5% (P =.12) and 46.7% vs 42.9%, respectively. Conclusion: This study did not find a significant change in 30-day re-presentation rate with a pharmacy-driven COPD TOC service. It did find that a significant number of patients admitted with COPD exacerbation may need an inhaler change, and demonstrates the utility of this kind of TOC service for identifying and correcting medication-related problems unique to this disease state. There were opportunities for improvement in percent of patients receiving the full intended intervention. [ABSTRACT FROM AUTHOR]

Background: Medication reconciliation has been shown to reduce medication-related errors in hospitalized patients, but the impact of pharmacy-led medication reconciliation in the intensive care unit (ICU) has not been extensively studied. Methods: This was a retrospective chart review of patients with a pharmacy-led medication reconciliation on admission to an ICU between January 1st and March 31st, 2018. Pharmacy-led medication reconciliations were completed by pharmacists, pharmacy residents, and pharmacy students. The objective of this study was to describe medication discrepancies identified by pharmacy-led medication reconciliation and to evaluate the interventions following. Results: A total of 288 patients were screened and 247 met inclusion criteria. There were 1148 medication discrepancies identified resulting in an average of 4.65 discrepancies per patient. Medication addition (54.25%) and medication deletion (45.75%) were most common. Within 24 hours of medication reconciliation, 214 interventions were made to active orders. No differences were observed between discrepancies identified and type of pharmacy staff completing the medication reconciliation. Conclusions: This study identified a high rate of medication discrepancies on admission to the ICU. Furthermore, it describes the types of pharmacist interventions following pharmacy-led medication reconciliation. This process may be impactful to incorporate as a standard practice in ICUs and warrants further investigation into value, cost, and pharmacist workflow. [ABSTRACT FROM AUTHOR]

Purpose: Oncology patients often struggle to manage their medications and related adverse events during transitions of care. They are expected to take an active role in self-monitoring and timely reporting of their medication safety events or concerns to clinicians. The purpose of this study was to explore the factors influencing oncology patients’ willingness to report adverse events or concerns related to their medication after their transitions back home. Methods: A qualitative interview study was conducted with adult patients with breast, prostate, lung, or colorectal cancer who experienced care transitions within the previous year. A semi-structured interview guide was developed to understand patients’ perceptions of reporting mediation-related safety events or concerns from home. All interviews were conducted via phone calls, recorded, and transcribed for thematic data analysis. Results: A total of 41 individuals participated in the interviews. Three main themes and six subthemes emerged, including patients’ perceived relationship with clinicians (the quality of communication and trust in clinicians), perceived severity of adverse medication events (perceived severe vs. non-severe events), and patient activation in self-management (self-efficacy in self-management and engagement in monitoring health outcomes). Conclusion: The patient-clinician relationship significantly affects patients’ reporting behaviors, which can potentially interact with other factors, including the severity of adverse events. It is important to engage oncology patients in medication safety self-reporting from home by enhancing health communication, understanding patients’ perceptions of severe events, and promoting patient activation. By addressing these efforts, healthcare providers should adopt a more patient-centered approach to enhance the overall quality and safety of oncological care. [ABSTRACT FROM AUTHOR]

As patients transition between health care settings, they are at an increased risk of adverse events and medication errors as a result of medication changes and miscommunication. Pharmacists have traditionally provided transitions of care (TOC) services, including patient education, in a face-to-face manner with the goal of reducing medication errors and enhancing patient safety and understanding. However, changes in care delivery models, a burdened health care workforce, and diminishing resources necessitate innovative approaches for the provision of patient education within TOC. Pharmacists should consider novel approaches to expand scope, reduce barriers, and creatively use existing resources to optimize patient education in TOC. [ABSTRACT FROM AUTHOR]

This article discusses the role of pharmacists in age-based health care transitions for adolescents with chronic conditions. It emphasizes the need for healthcare institutions to implement programs and initiatives to support these transitions and highlights the risks associated with poor healthcare transition processes. The article suggests that pharmacists are often overlooked in current guidance on age-based health care transitions and provides resources and opportunities for pharmacists to contribute to these transitions. However, there is a lack of literature on the role of pharmacists in this area, and more research is needed to understand their impact and outcomes. Overall, pharmacists are uniquely positioned to improve the transition process for adolescents with chronic conditions. [Extracted from the article]

Background: As a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients' multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program. Methods: To ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher's exact test for categorical variables, Student's t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions. Discussion: This study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions. [ABSTRACT FROM AUTHOR]

Background: Patients with palliative care needs are at high risk of medication errors during transitions of care (TOC). Palliative Care Pharmacist Interventions surrounding Medication Prescribing Across Care Transitions (IMPACT) program was developed to improve the TOC process from hospital to community setting for cancer patients followed by palliative care. We describe (1) the program and (2) pilot study feasibility and effectiveness data. Methods: We recorded pharmacist time, medication errors, drug therapy problems (DTPs), and palliative care provider satisfaction and compared 7- and 30-day readmissions and emergency department (ED) visits between IMPACT and usual care patients. Results: Forty-four patients were reached by the pharmacist. The pharmacist spent an average of 65 minutes per patient. An average of 14.9 medication reconciliation discrepancies per patient and a total 76 DTPs were identified. Seven-day readmissions were lower in the IMPACT group versus usual care; there were no differences in 30-day readmission or 7- or 30-day ED visits. Conclusion: Our pilot study demonstrates that integrating a pharmacist in TOC for seriously ill patients is feasible and valuable. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the impact of an embedded clinic infusion pharmacist on the retention of outpatient infusion therapy. Methods This was a single-center, pre-post, retrospective and prospective cohort study at a large quaternary care academic medical center. Outpatient infusion administrations were included in this study if they originated from a clinic with an embedded clinic infusion pharmacist and were targeted high-impact medications. The primary outcome was the impact of embedded clinic infusion pharmacists on the number of infusion administrations from before to after implementation. Secondary outcomes included the time from order entry to first infusion, return on investment (ROI), and level of utilization of various infusion centers. Outpatient infusion and injection administrations were divided into 2 cohorts: a preimplementation cohort administered from April 2021 to March 2022 and a postimplementation cohort administered from April 2022 to March 2023. Results A total of 12,257 outpatient infusion administrations were included in the study from the inflammatory bowel disease, Vanderbilt Eye Institute, and neurology clinics. As the embedded infusion pharmacists began working within the respective clinics, a statistically significant increase could be seen in the overall administration of high-impact medications (from 5,683 infusions before implementation to 6,574 infusions after implementation; P < 0.001). The ROI for an embedded clinic infusion pharmacist's services was greater than 2,500%. Conclusion Retention of outpatient infusion therapy can be significantly increased with a positive ROI through allocation of pharmacist resources to areas initiating infusions. Health systems can utilize this model to improve patient access to infusion and injection therapies at entity-owned clinics. [ABSTRACT FROM AUTHOR]

Background: Comprehensive medication management (CMM) is a service provided by clinical pharmacists. CMM aims to optimize pharmacotherapy outcomes by ensuring patients' medications are indicated, effective, safe, and patients are able to adhere to the prescribed medication regimen and take the medications as intended. The goal of CMM is to optimize patients' medications to ensure they are meeting their medication and health‐related goals. Objective: The objective of this project is to evaluate facilitators and barriers to integrating CMM during transitions of care (ToC) at Federally Qualified Health Centers (FQHCs). Design: Semistructured qualitative interviews were conducted with 22 key informants identified through purposive sampling at three FQHCs. Interviews were coded and analyzed deductively using a modified Consolidated Framework for Implementation Research (CFIR) adapted for ToC. Key Results: Thirty‐nine codes were identified across all CFIR constructs, including the addition of a new construct, "Patient characteristics." Major facilitators included the perceived advantage and feasibility of the intervention, standardization of ToC processes, and organizational buy‐in. Major barriers included health information technology system limitations, communication barriers with discharge facilities, technical and staffing challenges in applying criteria to identify patients for CMM, and low patient throughput. Conclusions: Identifying early‐stage barriers and facilitators are key to maximize facilitators and address barriers to support successful implementation. The findings of this work are being used to guide project adaptations to better integrate CMM into the ToC processes. [ABSTRACT FROM AUTHOR]

Previous studies in the ambulatory care setting have shown inconsistent results in regard to, or with respect to pharmacist telephonic transitions of care (TOC) encounters and reduction in 30-day readmission rates. No studies that have been completed within an accountable care organization (ACO) evaluating the impact of telephonic TOC encounters performed by a pharmacist have been identified. The objective of this study was to analyze the impact of clinical pharmacy telephonic TOC encounters on readmission rates within a primary care-based ACO. In this retrospective chart review, data for those who had a pharmacist telephonic TOC encounter and those who had an attempt were collected. The primary outcome of this study was allcause 30-day readmission rate. Secondary outcomes included 30-day readmission rate for targeted disease states, time to readmission, and readmission reason the same as previous discharge reason. For subjects who received a telephonic TOC encounter, pharmacist intervention type and provider acceptance of intervention(s) were described. For the final analysis, 154 encounters were included, 83 encounters in the telephonic TOC encounter group, and 71 did not receive a telephonic TOC encounter. The 30-day readmission rates were similar among those who received a telephonic TOC encounter and those who did not: the difference was not significant (15.7% vs. 28.2%; P = 0.059). There was also no statistical difference in the secondary outcomes. Even so, the results of this study suggest that performing a pharmacist telephonic TOC encounter in a primary care-based ACO setting has the potential to reduce 30-day readmission rates and further research appears to be warranted in this important area of practice. [ABSTRACT FROM AUTHOR]

Transitions of care often lead to medication errors and unnecessary healthcare utilization. Medication reconciliation has been repeatedly shown to reduce this risk. However, the great majority of evidence is limited to the provision of medication reconciliation within clinical trials and countries with wellestablished clinical pharmacy. Thus, this pragmatic, prospective, controlled trial evaluated the effectiveness of routine pharmacist-led medication reconciliation compared to standard care on medication errors and unplanned healthcare utilization in adult general medical patients hospitalized in a teaching hospital in Slovenia. All patients hospitalized in a ward where medication reconciliation was integrated into routine clinical practice were included in the intervention group and received admission and discharge medication reconciliation, coupled with patient counselling. The control group consisted of randomly selected patients from the remaining medical wards. The primary study outcome was unplanned healthcare utilization within 30 days of discharge, and the secondary outcomes were clinically important medication errors at hospital discharge and serious unplanned healthcare utilization within 30 days of discharge. Overall, 414 patients (53.4% male, median 71 years) were included--225 in the intervention group and 189 in the control group. In the intervention group, the number of patients with clinically important medication errors at discharge was significantly lower (intervention vs control group: 9.3% vs 61.9%). Multiple logistic regression revealed that medication reconciliation reduced the likelihood of a clinically important medication error by 20-fold, while a higher number of medications on admission was associated with an increased likelihood. However, no significant differences were noted in any and serious unplanned healthcare utilization (intervention vs control group: 33.9% vs 27.8% and 20.3% vs 14.6%, respectively). The likelihood of serious healthcare utilization increased with the age of the patient, the number of medications on admission and being hospitalized for an acute medical condition. Our pragmatic trial confirmed that medication reconciliation, even when performed as part of routine clinical practice, led to a substantial reduction in the risk of clinically important medication errors at hospital discharge but not to a reduction in healthcare utilization. Medication reconciliation is a fundamental, albeit not sufficient, element to ensure patient safety after hospital discharge. [ABSTRACT FROM AUTHOR]

Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient's medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital's outpatient CPEP within 30-days (P =.012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P =.024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to characterize opioid intensity in the intensive care unit (ICU) and its association with opioid utilization across care transitions. Methods: This is a prospective cohort study. Medically ill ICU patients with complete medication histories who survived to discharge were included. Opioid intensity was characterized based on IV morphine milligram equivalents (IV MME). Primary outcomes were opioid prescribing upon ICU and hospital discharge. Results: Opioids were prescribed to 34.1% and 31.1% of patients upon ICU and hospital discharge. Within the ≥50 mean IV MME/ICU day cohort, 64.7% of patients received opioids after ICU discharge compared to 45.8% and 13.6% in the 1-49 mean IV MME/ICU day and no opioid groups (P <.05). Within the ≥50 mean IV MME/ICU day cohort, 70.6% of patients were prescribed opioids after hospitalization compared to 37.3% and 13.6% of patients who received less or no opioids. (P <.05). Within the ≥50 mean IV MME/ICU day cohort, 29.4% of patients were opioid naïve and discharged with an opioid, which is over double compared to patients with lower opioid requirements (P <.05). Conclusion: Patients with higher mean daily ICU opioid requirements had increased opioid prescribing across care transitions despite preadmission opioid use. [ABSTRACT FROM AUTHOR]

Pharmacist‐led interventions may reduce the inappropriate continuation of acid‐suppressive agents and antipsychotics temporarily initiated in the intensive care unit (ICU), but limited data exist for other medications. This study evaluated the impact of a pharmacist‐led intervention on the number of medications inappropriately continued upon ICU and hospital discharge. This was a single‐center, pre‐post intervention analysis conducted in the medical and surgical ICUs at a tertiary academic medical center. The pre‐ and post‐intervention groups included adults who were newly initiated on medications used for stress ulcer prophylaxis, delirium, agitation, wakefulness, sedation, and insomnia from December 1, 2021 to January 31, 2022 and December 12, 2022 to February 13, 2023, respectively. In the post‐intervention group, pharmacists identified patients who were newly initiated on a medication of interest and documented in patients' charts via an electronic handoff tool utilizing a standardized template. The appropriateness of those medications was assessed daily, and pharmacists intervened when necessary. The number of medications inappropriately continued at ICU and hospital discharge and ICU and hospital lengths of stay were compared. Overall, 399 encounters were included in the final analysis, and a total of 459 medications were newly initiated in the ICU. There was no significant difference in the number of medications inappropriately continued at hospital discharge [22 (8.4%) vs. 10 (5.1%); p = 0.17]. Significantly fewer medications were inappropriately continued at ICU discharge in the post‐intervention group [85 (32.3%) vs. 37 (18.9%); p < 0.01]. The median ICU length of stay was significantly greater in the post‐intervention group [4 (2–8) vs. 2 (1–6) days; p < 0.01]. No significant difference was found in the median hospital length of stay [14 (7–26.5) vs. 16 (9–33.75) days; p = 0.08]. Use of an electronic handoff tool was associated with a significant reduction in the number of medications inappropriately continued at ICU discharge. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States, and one in five COPD hospitalizations result in a readmission within 30 days. Pharmacists have been identified as key members of interdisciplinary teams to improve transitions of care. Objective: The objective of this study was to develop, implement, and evaluate outcomes for a pharmacist‐driven COPD transitions of care bundle at an academic medical center. Methods: A COPD care bundle was implemented for patients presenting with a COPD exacerbation from December 1, 2021 to February 28, 2022. A historical control group was created from patients who were discharged between December 1, 2020 and February 28, 2021. Patient characteristics, pharmacist‐driven interventions, and time required for the intervention were assessed descriptively. Inhaler technique was assessed before and after pharmacist education utilizing standardized rubrics. The percentage change in inhaler scores was assessed with a Wilcoxon signed‐rank test. Readmission outcomes were analyzed using a chi‐squared test. Results: There were 30 patients in the intervention group and 46 in the control group. There were 104 interventions requiring provider collaboration, of which 84 (81%) were accepted. A median (interquartile range, IQR) of 46 (37–55) min was spent per patient in the intervention group. At baseline, patients scored a median of 84.6% (75–100) of steps correctly across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% [92.3–100] (p < 0.0001). There were eight (26.7%) 30‐day all‐cause readmission rates in the intervention group and 15 (32.6%) in the control group (p = 0.58). Conclusion: Most pharmacist recommendations were accepted by providers. Medication education led to improved understanding of inhaler technique, but there was no difference in 30‐day readmission rates. Further development of this service is warranted based on these findings. [ABSTRACT FROM AUTHOR]

Abstract Background The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. Methods An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. Results Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. Conclusions We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. Trial registration ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

Vascular anomalies (VAs) are a group of rare diseases affecting 0.01 to 0.02% of the population. VA may be associated with complex disorders affecting multiple organ systems, requiring a multidisciplinary approach to treatment. Multidisciplinary clinics are most frequently affiliated with pediatric centers. Multidisciplinary clinics in the adult setting are rare. Many adult VA patients find it difficult to establish care with individual providers, let alone a multidisciplinary clinic, leading to barriers to lifelong comprehensive care. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation (CR) is underutilized in Canada. Little is known about individuals' experiences with CR programs and the social contexts that shape program participation. Purpose: To explore individuals' experiences with using CR programs. Methods: We conducted an interpretive description study. Data analysis involved thematic analysis. Results: Participants' (N = 19) concerns centred around three themes: finding a way to get into the program; making this work; and the appropriateness of the program. Conclusion: Participants' experiences in CR programs involve challenges related to their personal lives, healthcare provider referral practices to CR programs, and the structure of these programs. Implications for Practice: There is a need for harmonized CR program referral systems that allow for better connection between specialty care and primary care. CR programs must emphasize patient education, interpersonal communication, and relational practice to enhance the trust of CR participants. Cardiovascular nurses can play a pivotal role in achieving these outcomes. [ABSTRACT FROM AUTHOR]

Objective: Expand upon previous reviews conducted on transitions of care (TOC) services with a focus on pharmacist interventions for older adults specifically transitioning to and from long-term care, acute rehabilitation, residential care facilities, care homes, skilled nursing, or assisted living facilities, collectively termed patient care centers (PCC). Data Sources: A PubMed and Ovid MEDLINE search was conducted including citations between 1974 and July 14, 2022. Bibliographies were also reviewed for additional citations. Methods: Articles included described pharmacist interventions during TOC for patients transitioning to and from PCC, were written in English, and reported outcomes pertaining to TOC services. Of 873 citations reviewed, 22 articles met the inclusion criteria. Results: Most studies were prospective in design with small sample sizes, of limited duration, and with varying interventions and reported outcomes. Most explored the transition from hospital to PCC and included a pharmacist intervention involving the identification of medication errors and discrepancies during the TOC. Few studies reported cost savings or 30- and 60-day reductions in readmission rates or mortality. Conclusions: This scoping review revealed a lack of robust clinical trials to assess the effectiveness of specific interventions performed by pharmacists for patients transitioning to and from PCC. Of the available data, pharmacist involvement within an interprofessional team can be an effective intervention to resolve medication discrepancies, reduce readmissions, and medication-related adverse events. An opportunity exists for future studies to explore ways to improve outcomes during TOC within PCC. [ABSTRACT FROM AUTHOR]

Study Objective: A pharmacy practice model for an Advanced Heart Failure (HF)/Transplant program was designed to address gaps in medication access, medication education and transitions of care (ToC). Activities specific to these initiatives performed by a four-member pharmacy team (3 pharmacists, 1 specialty technician) are described. Methods: Data were prospectively collected in 2020 for 284 admissions involving a high-risk cohort of advanced HF/transplant patients and a similar cohort seen in an ambulatory HF clinic. Interventions including medication reconciliation, e-prescribing, patient consultation and telephone call backs were performed daily to ensure medication access on discharge and as outpatients, comprehensive medication education on a continuum, and improved ToC. Metrics specific to these interventions and revenue reflecting outpatient prescription volume were quantified. Results: Standardized discharge medication education was provided to 97% of the cohort (n = 275). Of the 51 patients newly transplanted or receiving a left ventricular assist device, 100% had medication access on discharge and received follow-up telephone consultation within 48 hours. ToC was performed on admission (97%), pre-operatively (n = 51; 100%), post-operatively (n = 51; 100%) and on discharge (97%). Outpatient prescription volume increased 42% with net revenue increasing 157%. Conclusion: A pharmacy practice model involving an integrated 4-member team improved medication access and education and allowed for ToC at multiple points in the care process thereby improving medication safety. Collaboration between pharmacists and technicians working in inpatient, outpatient and specialty pharmacy settings is encouraged to provide complementary care to high-risk patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to determine the clinical impact of a specialized pharmacist-led medication assessment on the incidence of dopamine antagonists administered for patients with Parkinson's disease after deep brain stimulation (DBS). METHODS: This was a single-center, Institutional Review Board-approved, two-phase study with pre- and postimplementation cohorts of patients who were 18 years of age or older who underwent DBS for treatment of Parkinson's disease. The primary endpoint was the incidence of dopamine antagonists administered after DBS procedure. Secondary endpoints included the incidence of dopamine antagonists ordered; restarting home Parkinson's disease regimen; rate of tardive dyskinesia; length of hospital stay; and incidence of sitters, restraints, and medications administered for acute agitation. Statistical analysis included Fisher's exact test for categorical data, unpaired t-test for continuous data, and descriptive statistics for all other data. RESULTS: The incidence of dopamine antagonists administered was 1 (1.2%) versus 1 (25%) for the pre- and post-implementation groups, respectively (P = 0.09). Restarting of home Parkinson's disease regimen was 30 (36.1%) versus 4 (100%); P = 0.021. The average length of stay was 1.9 days versus 1.3 days. Incidence of sitters was 1 (1.2%) versus 0 (0%), and incidence of restraints was 0 (0%) versus 0 (0%). Incidence of acute agitation medications administered was 9 (10.8%) versus 0 (0%). The secondary endpoints were not significant except for the restarting of home medication regimen. CONCLUSION: The specialized pharmacist-led medication review service identified a single incident of inappropriate medications administered for Parkinson's disease patients status post DBS. However, it did significantly increase the incidence of the restart of Parkinson's disease home regimen. [ABSTRACT FROM AUTHOR]

The Pharmacists' Patient Care Process (PPCP) is woven throughout the doctor of pharmacy program; however, advanced pharmacy practice experiences (APPEs) are not structured in a specific order allowing students to apply the PPCP across the care continuum. Two faculty preceptors from two practice sites, inpatient family medicine and ambulatory care, joined to provide twice weekly, preceptor-led collaborative topic discussions to bridge this gap. This paper describes an approach to improve students' knowledge by incorporating progressive cases and assessments highlighting care across the continuum aligned with the PPCP. Preceptors developed topic discussions, progressive cases, and assessments to emphasize the PPCP and transitions of care (TOC) during month-long APPEs. Students' perceptions were assessed through an anonymous Likert-type item survey. To assess learning, students completed anonymous, preceptor-developed, multiple-choice pre- and post-assessments aligned with the different components of the PPCP and TOC. In two academic years (2021−2023), 24 perception surveys were distributed and 21 were received from 19 unique students (87.5%). Compared to pre-implementation surveys, a significant increase was seen in the students strongly agreeing the incorporation of progressive cases improved their ability to apply the PPCP to patient care (48% vs. 76%, P value =.06). Twenty-four pre- and post-assessments (100%) were completed by 22 unique students, showing a statistically significant difference in students' understanding of content (71.8% vs. 81.6%, P value =.02). The incorporation of collaborative topic discussions for APPE students between inpatient and ambulatory care preceptors increased students' knowledge to apply the PPCP during TOC. [ABSTRACT FROM AUTHOR]

Pharmacist involvement in transitions of care has been shown to improve patient outcomes and reduce readmission rates. Pharmacists reduce medication errors at discharge by ensuring all home medications continued are appropriate, provide pharmacist discharge patient medication education on new and existing medications therapies, and evaluate the safety and efficacy of the patient's medication therapy in order to decrease readmission rates. Results from this study may provide a financial benefit for hospital reimbursement by reducing 30 day readmission rates. The primary outcome was the comparison of composite emergency department (ED) and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus standard of care. Patients 18 years of age and older with a readmission risk score of 25 or greater, and admitted on general medicine floors from November 1, 2022 through February 28, 2023 were included. Patients were randomized into a standard of care (SOC) or extended SOC group. The primary outcome was the comparison of composite ED and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus SOC. A key secondary outcome included number of drug‐related problems identified and resolved. The primary outcome was analyzed using chi‐squared analysis (alpha of 0.05) and secondary outcomes as descriptive statistics. Data was analyzed using Stata® 16.1 statistical software. Two hundred and ninety‐six patients were included for analysis with 148 patients in both extended SOC and SOC groups. Extended SOC decreased the composite 30 day ED visit and hospital readmission rate by 7% (p = 0.63). Extended SOC group decreased 30 day ED visits by 4.9% and inpatient 30 day readmissions by 8.2% analyzed using descriptive statistics. Patients in extended SOC group resulted in a non‐statistical decrease in ED visits and inpatient readmissions 30 days after discharge compared to SOC group. [ABSTRACT FROM AUTHOR]

Medications for opioid use disorder (MOUD) are especially important for formerly incarcerated individuals with opioid use disorder (OUD) and can reduce the risk of re-arrest and overdose during community reentry. Unfortunately, few formerly incarcerated individuals are able to access MOUD within the community, missing a critical tool for rehabilitation. A mini narrative review was conducted to highlight the published work that has been done to improve access to MOUD for formerly incarcerated individuals during reentry. The results yielded 15 records describing intervention evaluations, program descriptions, and research in progress. Most work is ongoing, showing promise that researchers have identified the importance of this problem. However additional research should be done to include other stakeholders and address the limitations of existing interventions and programs. Continued efforts can help ensure that formerly incarcerated individuals can safely and successfully reintegrate into society.

BackgroundIntensive care unit (ICU)-ward patient transfers are inherently high risk, and clinician miscommunication has been linked to adverse events and negative outcomes. Despite these risks, few educational tools exist to improve resident handoff communication at ICU-ward transfer.ObjectiveWe used human-centered design (HCD) methods to cocreate a novel electronic health record ICU-ward transfer tool alongside Internal Medicine residents at three academic hospitals.MethodsWe conducted HCD workshops at each hospital, performing process mapping, brainstorming, and rapid prototyping. We performed thematic analysis on verbatim-transcribed workshop audio recordings to inform development and adaptation of the final resident prototype into the ICU-PAUSE tool.ResultsICU-PAUSE focuses on reasons for ICU admission and problem-based ICU course (I); Code status, goals of care, and family contacts (C); a diagnostic pause acknowledging Uncertainty (U); Pending tests (P); Active consultants (A); high-risk medications, including medications to be Unprescribed (U); Summary of problems and to-dos (S); and a current physical Exam (E).ConclusionWe used HCD to cocreate a novel, more user-friendly electronic ICU-ward transfer tool, ICU-PAUSE, alongside Internal Medicine trainees. Future steps will involve formal usability testing, evidence-driven implementation, and clinical evaluation of ICU-PAUSE across multiple hospitals.

Abstract Background Older patients often experience safety issues when transitioning from hospital to home. The ‘Your Care Needs You’ (YCNY) intervention aims to support older people to ‘know more’ and ‘do more’ whilst in hospital so that they are better prepared for managing at home. Methods A multi-centre cluster randomised controlled trial (cRCT) will evaluate the effectiveness and cost-effectiveness of the YCNY intervention. Forty acute hospital wards (clusters) in England from varying medical specialities will be randomised to deliver YCNY or care-as-usual on a 1:1 basis. The primary outcome will be unplanned hospital readmission rates within 30 days of discharge. This will be extracted from routinely collected data of at least 5440 patients (aged 75 years and older) discharged to their own homes during the 4- to 5-month YCNY intervention period. A nested cohort of up to 1000 patients will be recruited to the study to collect secondary outcomes via follow-up questionnaires at 5-, 30- and 90-day post-discharge. These will include measures of patient experience of transitions, patient-reported safety events, quality of life and healthcare resource use. Unplanned hospital readmission rates at 60 and 90 days of discharge will be collected from routine data. A process evaluation (primarily interviews and observations with patients, carers and staff) will be conducted to understand the implementation of the intervention and the contextual factors that shape this, as well as the intervention’s underlying mechanisms of action. Fidelity of intervention delivery will also be assessed across all intervention wards. Discussion This study will establish the effectiveness and cost-effectiveness of the YCNY intervention which aims to improve patient safety and experience for older people during transitions of care. The process evaluation will generate insights about how the YCNY intervention was implemented, what elements of the intervention work and for whom, and how to optimise its implementation so that it can be delivered with high fidelity in routine service contexts. Trial registration UK Clinical Research Network Portfolio: 44559; ISTCRN: ISRCTN17062524. Registered on 11/02/2020.