The effect of an improved collaboration between secondary and primary care on drug-related problems post-discharge.

Background A hospital discharge is a critical period with respect to patient safety. Lack of communication, inadequate transfer of information between secondary and primary care and the patient can result in drug-related problems (DRPs). The objective of this study was to investigate the effect of an improved collaboration between secondary and primary care on the amount of DRPs post-discharge. Methods A prospective controlled multicenter study was conducted in two hospitals (OLVG and BovenIJ) and fifty community pharmacies in Amsterdam. Patients discharged from the internal medicine-, neurology-, cardiologyand pulmonology departments were included if at least one medication change was initiated during admission. Usual care patients received routine care: medication reconciliation at hospital admission and discharge by pharmacy technicians and pharmaceutical consultants (specialized pharmacy technicians). Intervention patients additionally received teach back at hospital discharge to assess whether the patient could specify which medication had changed during admission. Also, primary care providers (i.e. community pharmacy, general practitioner, home healthcare nurses) received a medication overview listing (reasons for) all in-hospital medication changes. Finally, the patient's community pharmacist performed a home visit ≤5 days post-discharge. Four weeks post-discharge DRPs (adverse drug events, practical problems, doubts and concerns on the effectiveness and safety of medication) were assessed during a structured telephone interview (primary outcome). Also, knowledge regarding all medication changes implemented in the hospital and satisfaction with medication use were measured. Data were analysed by means of descriptive statistics. The independent T test was used for continuous variables and the Chi square test for frequencies. Ordinal logistic regression analyses were performed adjusting for confounders. P-values and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results In total 456 patients were included (usual care: n = 234, intervention: n = 222). DRPs decreased significantly from 66% in the usual care group to 52% in the intervention group (P < 0.01, adjusted OR 0.57 (95% CI 0.37- 0.89)), primarily due to decreased post-discharge adverse drug events (25% versus 16%; P < 0.05). Furthermore knowledge regarding all medication changes implemented in the hospital improved significantly in the intervention group (30% versus 42%; P < 0.05). In total, 82% of the patients in the intervention group reported that they were satisfied with their medication compared to 68% in the usual care group (P < 0.01). Conclusion This study highlights the importance of an improved collaboration between primary and secondary healthcare providers to ensure continuity of care and to reduce patient harm due to medication. DRPs were significantly reduced [ABSTRACT FROM AUTHOR]