title: Impact of medication reconciliation at discharge on continuity of patient care in France.
abstract: Background Care transitions from hospital to community have been identified as risk points for the continuity of patient care. Without upstream information, the community pharmacist (CP) cannot ensure error-free drug dispensing. A hospital-to-community records transmission process would enable CPs to guarantee that all prescription drugs are ready to pick up at hospital discharge, and to improve their responses to patient health inquiries. Objective To evaluate the impact of a hospital-to-CP medication records scheme on post-discharge continuity of patient treatment. Setting A University Hospital Digestive Surgery Department. Method Prospective, single-center, randomized pilot study. Eligible adult Digestive Surgery department patients discharged home over a period of 4 months were included. The medication reconciliation procedure was the same in both arms of the study. For patients included in the intervention group, CPs were sent the discharge prescription, patient medication list, and clinical and biological data required for drug dispensing. At 7 ± 2 days post-discharge, the CPs were surveyed by questionnaire. Seamlessness of drug continuity, use of the discharge medication form, and CP satisfaction with the scheme were assessed. Main outcome measures Prevalence of medication shortages, i.e. CPs unable to supply the appropriate drugs at discharge, and CP satisfaction levels, analyzed using Chi squared test. Results 124 patients were included. Of 124 CPs surveyed, 104 returned a completed questionnaire. Analysis found medication shortage in 10 control-group patients and one intervention-group patient (p < 0.005), non-availability of the full prescription in 24 % of control-group patients and 6 % of intervention-group patients (p < 0.013). In terms of CP satisfaction, 96 % of the intervention-group CPs stated that they were satisfied with the new hospital-to-community liaison initiative, while just 24 % of control-group CPs were satisfied with the current level of hospital-to-community liaison. Mean hospital pharmacist time input required for this initiative was an estimated 21 min for the control group versus 35 min for the intervention group. Conclusion The results provide a strong rationale for embedding the process longer-term and extending it out to other healthcare services. A pre-project study is needed to define which service departments and patients groups should be given priority for this process initiative.
authors.affiliation: Pharmacy Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France. m.v.h@hotmail.fr.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Van Hollebeke
authors.affiliation: Pharmacy Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Talavera-Pons
authors.affiliation: Clinical Research and Innovation Office, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Pharmacy Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Sautou
authors.affiliation: Gastro Enterology Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bommelaer
authors.affiliation: Gastro Enterology Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Armand
authors.initials: A
authors.lastname: Abergel
authors.affiliation: Pharmacy Department, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Boyer
mesh_terms: D000368:Aged; D003157:Community Pharmacy Services / Q000639:trends; D003266:Continuity of Patient Care / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000379:methods / Q000639:trends*; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D010595:Pharmacists / Q000639:trends*; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000639:trends*; D010865:Pilot Projects; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D024382:Professional Role; D011446:Prospective Studies
chemical_list: D055553:Prescription Drugs
keywords: Community pharmacy; Continuity of treatment; France; Hospital discharge; Seamless care