Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
Department of Clinical Pharmacology and Pharmacy, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
Res Social Adm Pharm. 2022 Apr;18(4):2651-2658. doi: 10.1016/j.sapharm.2021.05.009. Epub 2021 May 21.
Transitional care programs (i.e. interventions delivered both in hospital and in primary care), could increase continuity and consequently quality of care. However, limited studies on the effect of these programs on Adverse Drug Events (ADEs) post-discharge are available. Therefore, the aim of this study was to investigate the effect of a transitional pharmaceutical care program on the occurrence of ADEs 4 weeks post-discharge.
A multicentre prospective before-after study was performed in a general teaching hospital, a university hospital and 49 community pharmacies. The transitional pharmaceutical care program consisted of: teach-back to the patient at discharge, a pharmaceutical discharge letter, a home visit by a community pharmacist and a clinical medication review by both the community and the clinical pharmacist, on top of usual care. Usual care consisted of medication reconciliation at admission and discharge by pharmacy teams. The primary outcome was the proportion of patients who reported at least 1 ADE 4 weeks post-discharge. Multivariable logistic regression was used to adjust for potential confounders.
In total, 369 patients were included (control: n = 195, intervention: n = 174). The proportion of patients with at least 1 ADE did not statistically significant differ between the intervention and control group (general teaching hospital: 59% vs. 67%, OR 0.70 [95% CI 0.38-1.31], university hospital: 63% vs 50%, OR 1.76 [95% CI 0.75-4.13]).
The transitional pharmaceutical care program did not decrease the proportion of patients with ADEs after discharge. ADEs after discharge were common and more than 50% of patients reported at least 1 ADE. A process evaluation is needed to gain insight into how a transitional pharmaceutical care program could diminish those ADEs.
过渡护理计划（即在医院和初级保健机构中提供的干预措施）可以提高连续性，进而提高护理质量。然而，关于这些计划对出院后不良药物事件（ADE）的影响的研究有限。因此，本研究旨在调查过渡性药物治疗计划对出院后 4 周发生 ADE 的影响。
在一家综合教学医院、一家大学医院和 49 家社区药房进行了一项多中心前瞻性前后研究。过渡性药物治疗计划包括：出院时向患者进行教学回顾、药物出院信、社区药剂师家访以及社区和临床药剂师对药物进行临床审查，除此之外还包括常规护理。常规护理包括入院和出院时由药房团队进行药物重整。主要结局是报告至少 1 例出院后 4 周内发生 ADE 的患者比例。采用多变量逻辑回归调整潜在混杂因素。
共纳入 369 例患者（对照组：n=195，干预组：n=174）。干预组和对照组出院后至少有 1 例 ADE 的患者比例无统计学差异（综合教学医院：59% vs. 67%，OR 0.70[95%CI 0.38-1.31]；大学医院：63% vs. 50%，OR 1.76[95%CI 0.75-4.13]）。
过渡性药物治疗计划并未降低出院后 ADE 患者的比例。出院后 ADE 很常见，超过 50%的患者报告至少发生 1 例 ADE。需要进行过程评估，以了解过渡性药物治疗计划如何减少这些 ADE。
