Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA.
From the University of Massachusetts Memorial Health Care.
J Patient Saf. 2020 Dec;16(4):e367-e375. doi: 10.1097/PTS.0000000000000571.
The aim of the study was to assess the feasibility, satisfaction, and effectiveness of a care transition intervention with pharmacist home visit and subsequent anticoagulation expert consultation for patients with new episode of venous thromboembolism within a not-for-profit health care network.
We randomized patients to the intervention or control. During the home visit, a clinical pharmacist assessed medication management proficiency, asked open-ended questions to discuss knowledge gaps, and distributed illustrated medication instructions. Subsequent consultation with anticoagulation expert further filled knowledge gaps. At 30 days, we assessed satisfaction with the intervention and also measured the quality of care transition, knowledge of anticoagulation and venous thromboembolism, and anticoagulant beliefs (level of agreement that anticoagulant is beneficial, is worrisome, and is confusing/difficult to take).
The mean ± SD time required to conduct home visits was 52.4 ± 20.5 minutes and most patients agreed that the intervention was helpful. In general, patients reported a high-quality care transition including having been advised of safety issues related to medications. Despite that, the mean percentage of knowledge items answered correctly among patients was low (51.5 versus 50.7 for intervention and controls, respectively). We did not find any significant difference between intervention and control patients for care transition quality, knowledge, or anticoagulant beliefs.
We executed a multicomponent intervention that was feasible and rated highly. Nevertheless, the intervention did not improve care transition quality, knowledge, or beliefs. Future research should examine whether alternate strategies potentially including some but not all components of our intervention would be more impactful.
本研究旨在评估一项针对非营利性医疗保健网络中新发静脉血栓栓塞症患者的药师家访和随后抗凝专家咨询的过渡护理干预措施的可行性、满意度和效果。
我们将患者随机分配至干预组或对照组。在家庭访视期间，临床药师评估药物管理能力，提出开放式问题以讨论知识差距，并分发说明药物使用的插图说明。随后与抗凝专家进行咨询，进一步填补知识空白。在 30 天时，我们评估了对干预措施的满意度，并测量了过渡护理的质量、抗凝和静脉血栓栓塞症的知识以及抗凝剂信念（对抗凝剂有益、令人担忧以及难以服用的程度）。
进行家访所需的平均时间为 52.4±20.5 分钟，大多数患者认为干预措施很有帮助。总的来说，患者报告了高质量的过渡护理，包括被告知与药物相关的安全问题。尽管如此，患者答对的知识项目的平均百分比仍较低（干预组和对照组分别为 51.5%和 50.7%）。我们未发现干预组和对照组患者在过渡护理质量、知识或抗凝剂信念方面存在任何显著差异。
我们实施了一项可行且评价较高的多组分干预措施。然而，该干预措施并未改善过渡护理质量、知识或信念。未来的研究应检验替代策略是否会更有效果，这些替代策略可能包括我们干预措施的一些但不是全部组成部分。
