Division of Cardiology, London Health Sciences Centre and St. Joseph's Health Care, London, Ontario, Canada
Department of Medicine, Western University, London, Ontario, Canada.
BMJ Open Qual. 2020 May;9(2). doi: 10.1136/bmjoq-2019-000849.
Lack of prescription adherence after discharge from the inpatient hospital setting is a barrier to the delivery of optimal patient care. Non-adherence to medication for cardiac diseases can lead to substantial morbidity, mortality and healthcare costs. Electronic delivery of prescriptions by fax is a potential method of improving patient satisfaction and reducing pharmacy wait times.
This study was completed in the cardiology inpatient wards at a hospital in London, Ontario, Canada. 'Delayed prescription retrieval' was defined as the retrieval of a prescribed medication by a patient from their local pharmacy after the documented calendar day of discharge. The current discharge process on the cardiology wards was assessed and an initial monitoring period of study participants was completed to determine the baseline delayed prescription retrieval rate (preintervention group). A formalised discharge process, which included electronic delivery of prescriptions to pharmacies by fax, was implemented for study participants (postintervention group). The rate of delayed prescription retrieval was assessed in both groups.
15 of 42 patients (35.7%) in the preintervention group and 9 of 72 (14.3%) in the postintervention group had delayed prescription retrieval suggesting relative and absolute risk reductions of 65% and 23.2% (p=0.0045). Of the participants with delayed prescription retrieval, 100% in the preintervention group and 77.8% in the postintervention group were due a new prescribed medication on the day of discharge.
Patients who experienced a formalised discharge process, which included electronic delivery of prescriptions by fax, at the time of discharge from cardiac inpatient care had a lower rate of delayed prescription retrieval. Future studies are required to examine the impact of formal discharge processes on patient morbidity and mortality.
从住院医院环境出院后缺乏处方依从性是提供最佳患者护理的障碍。心脏疾病药物治疗不依从会导致大量发病、死亡和医疗保健费用。通过传真发送电子处方是提高患者满意度和减少药房等待时间的一种潜在方法。
这项研究是在加拿大安大略省伦敦的一家医院的心脏病住院病房进行的。“延迟处方取药”定义为患者从当地药房取走规定药物的时间超过记录的出院日。评估了心脏病病房的现行出院流程，并对研究参与者进行了初始监测期，以确定延迟处方取药率的基线（干预前组）。为研究参与者实施了正式的出院流程，包括通过传真向药房发送电子处方（干预后组）。评估了两组的延迟处方取药率。
干预前组的 42 名患者中有 15 名（35.7%）和干预后组的 72 名患者中有 9 名（14.3%）出现了延迟处方取药，这表明相对风险降低了 65%，绝对风险降低了 23.2%（p=0.0045）。在出现延迟处方取药的患者中，干预前组的 100%和干预后组的 77.8%在出院当天需要新的处方药物。
在从心脏住院治疗出院时经历了正式的出院流程，包括通过传真发送电子处方的患者，其延迟处方取药率较低。需要进一步研究正式的出院流程对患者发病率和死亡率的影响。
