Department of Hospital Pharmacy, Amsterdam, The Netherlands.
BMC Health Serv Res. 2010 Feb 16;10:39. doi: 10.1186/1472-6963-10-39.
Medication errors occur frequently at points of transition in care. The key problems causing these medication errors are: incomplete and inappropriate medication reconciliation at hospital discharge (partly arising from inadequate medication reconciliation at admission), insufficient patient information (especially within a multicultural patient population) and insufficient communication to the next health care provider. Whether interventions aimed at the combination of these aspects indeed result in less discontinuity and associated harm is uncertain. Therefore the main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in patients discharged from the internal medicine department.
METHODS/DESIGN: An experimental study is performed at the internal medicine ward of a general teaching hospital in Amsterdam, which serves a multicultural population. In this study the effects of the COACH program is compared with usual care using a pre-post study design. All patients being admitted with at least one prescribed drug intended for chronic use are included in the study unless they meet one of the following exclusion criteria: no informed consent, no medication intended for chronic use prescribed at discharge, death, transfer to another ward or hospital, discharge within 24 hours or out of office hours, discharge to a nursing home and no possibility to counsel the patient.The intervention consists of medication reconciliation, patient counselling and communication between the hospital and primary care healthcare providers.The following outcomes are measured: the primary outcome readmissions within six months after discharge and the secondary outcomes number of interventions, adherence, patient's attitude towards medicines, patient's satisfaction with medication information, costs, quality of life and finally satisfaction of general practitioners and community pharmacists.Interrupted time series analysis is used for data-analysis of the primary outcome. Descriptive statistics is performed for the secondary outcomes. An economic evaluation is performed according to the intention-to-treat principle.
This study will be able to evaluate the clinical and cost impact of a comprehensive program on continuity of care and associated patient safety.
Dutch trial register: NTR1519.
在医疗护理交接点经常发生用药错误。导致这些用药错误的主要问题是：医院出院时的药物重整不完整和不适当（部分原因是入院时的药物重整不充分）、患者信息不足（尤其是在多文化患者群体中）以及与下一个医疗保健提供者沟通不足。针对这些方面的干预措施是否确实能减少不连续性和相关伤害尚不确定。因此，本研究的主要目的是确定 COACH 计划（适当药物治疗的连续性、患者咨询和医疗保健中的信息传递）对从内科出院的患者再入院率的影响。
方法/设计：在阿姆斯特丹一家普通教学医院的内科病房进行一项实验研究，该医院服务于一个多文化群体。在这项研究中，使用前后研究设计比较 COACH 计划的效果与常规护理。所有至少有一种规定用于慢性使用的药物的患者都被纳入研究，除非他们符合以下排除标准之一：无知情同意、无出院时规定用于慢性使用的药物、死亡、转至另一个病房或医院、24 小时内出院或下班时间、出院至疗养院以及无法对患者进行咨询。干预措施包括药物重整、患者咨询以及医院和初级保健医疗保健提供者之间的沟通。测量以下结果：主要结果为出院后 6 个月内的再入院率，次要结果为干预次数、依从性、患者对药物的态度、患者对药物信息的满意度、成本、生活质量，最后是全科医生和社区药剂师的满意度。使用中断时间序列分析对主要结果进行数据分析。对次要结果进行描述性统计。根据意向治疗原则进行经济评估。
本研究将能够评估全面计划对连续性护理和相关患者安全的临床和成本影响。
荷兰试验注册处：NTR1519。
