Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist-led interdisciplinary intervention to improve medication safety in older hospitalized patients.

Autor: Johansen JS; UiT The Arctic University of Norway, Tromsø, Norway., Halvorsen KH; UiT The Arctic University of Norway, Tromsø, Norway., Havnes K; UiT The Arctic University of Norway, Tromsø, Norway., Wetting HL; Hospital Pharmacy of North Norway Trust, Langnes, Norway., Svendsen K; UiT The Arctic University of Norway, Tromsø, Norway., Garcia BH; UiT The Arctic University of Norway, Tromsø, Norway.; Hospital Pharmacy of North Norway Trust, Langnes, Norway.
Jazyk: angličtina
Zdroj: Journal of clinical pharmacy and therapeutics [J Clin Pharm Ther] 2022 May; Vol. 47 (5), pp. 619-627. Date of Electronic Publication: 2021 Dec 21.
DOI: 10.1111/jcpt.13581
Abstrakt: What Is Known and Objective: The majority of hospitalized older patients experience medication-related problems (MRPs), and there is a call for interventions to solve MRPs and improve clinical outcomes like medical visits. The IMMENSE study is a randomized controlled trial investigating the impact of a pharmacist-led interdisciplinary intervention on emergency medical visits. Its multistep intervention is based on the integrated medicines management methodology and includes a follow-up step with primary care. This study aims to describe how the intervention in the IMMENSE study was delivered and its process outcomes.
Methods: The study includes the 221 intervention patients in the per-protocol group of the IMMENSE study. Both intervention delivery, reasons for not performing interventions and process outcomes were registered daily by the study pharmacists in a Microsoft Access ® database. Process outcomes were medication discrepancies, MRPs and how the team solved these.
Results and Discussion: A total of 121 (54.8%) patients received all intervention steps if appropriate. All patients received medication reconciliation (MedRec) and medication Review (MedRev) (step 1 and 2), while between 10% and 20% of patients were missed for medication list in discharge summary (step 3), patient counselling (step 4), or communication with general practitioner and nurse (step 5). A total of 437 discrepancies were identified in 159 (71.9%) patients during MedRec, and 1042 MRPs were identified in 209 (94.6%) patients during MedRev. Of these, 292 (66.8%) and 700 (67.2%), respectively, were communicated to and solved by the interdisciplinary team during the hospital stay.
What Is New and Conclusion: The fidelity of the single steps of the intervention was high even though only about half of the patients received all intervention steps. The impact of the intervention may be influenced by not implementing all steps in all patients, but the many discrepancies and MRPs identified and solved for the patients could explain a potential effect of the IMMENSE study.
(© 2021 The Authors. Journal of Clinical Pharmacy and Therapeutics published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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