LeBlanc Véronique C, Desjardins Audrey, Desbiens Marie-Pier, Dinh Christine, Courtemanche Fanny, Firoozi Faranak, Gilbert Suzanne, Moride Yola, Villeneuve Yannick
Faculty of Pharmacy, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada.
Department of Pharmacy, Jewish General Hospital, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, 3755 Côte-Sainte-Catherine Rd, Montreal, Quebec H3T 1E2, Canada.
Explor Res Clin Soc Pharm. 2021 Nov 17;5:100090. doi: 10.1016/j.rcsop.2021.100090. eCollection 2022 Mar.
During transitions of care, older adults are at risk of adverse drug events which could lead to avoidable hospital visits. Pharmacists are increasingly involved in care teams at various stages of the continuum of care. The types and frequency of clinical interventions performed by pharmacists in the geriatric practice setting remain poorly documented.
This study aimed to describe the current integration of pharmacist interventions during transitions of care of older adults admitted in short-term geriatric units (STGUs) and to explore barriers and facilitators to their implementation in clinical practice. The secondary objective was to explore associations between certain patient characteristics and pharmacist-led interventions during transitional care.
A mixed methods study was conducted with pharmacists practicing in STGUs in the Montreal area, Canada. The application of 8 pharmaceutical interventions was assessed using a self-administered questionnaire, along with as a retrospective chart review. Four semi-structured group interviews were conducted in order to identify perceived barriers and facilitators.
Thirteen pharmacists participated in the study. In the questionnaire, medication reconciliation on admission and at discharge was reported as being performed at least half the time by 12 (92%) and 7 (54%) pharmacists, respectively. The retrospective chart review revealed that these interventions were documented in 95 (98%) and 25 (26%) files, respectively. While 35% of patients had a documented pharmaceutical care plan on admission, none was documented at discharge. Several barriers to implementing clinical interventions were identified such as lack of time, technical support, communication and standardization.
Pharmacists are involved at different periods of transitional care; however, certain barriers should be addressed in order to expand their role in discharge planning. Providing guidelines on what is expected at discharge and post-discharge, and having a practice focused on delegation and collaboration would help pharmacists increase their role throughout the transition of care of older adults.
在医疗护理转接过程中，老年人面临药物不良事件风险，这可能导致可避免的住院情况。药剂师越来越多地参与到连续护理各个阶段的护理团队中。在老年医疗实践环境中，药剂师进行的临床干预的类型和频率记录仍不完善。
本研究旨在描述目前药剂师干预措施在短期老年病房（STGU）收治的老年人护理转接过程中的整合情况，并探讨其在临床实践中实施的障碍和促进因素。次要目的是探讨在过渡护理期间某些患者特征与药剂师主导的干预措施之间的关联。
对在加拿大蒙特利尔地区短期老年病房工作的药剂师开展了一项混合方法研究。使用一份自填式问卷评估8种药物干预措施的应用情况，并进行回顾性病历审查。进行了4次半结构化小组访谈，以确定感知到的障碍和促进因素。
13名药剂师参与了该研究。在问卷中，分别有12名（92%）和7名（54%）药剂师报告称入院和出院时至少有一半时间进行了用药核对。回顾性病历审查显示，这些干预措施分别在95份（98%）和25份（26%）病历中有记录。虽然35%的患者入院时有记录在案的药物治疗护理计划，但出院时均无记录。确定了实施临床干预的若干障碍，如时间不足、技术支持、沟通和标准化问题。
药剂师参与了过渡护理的不同阶段；然而，为扩大其在出院计划中的作用，应解决某些障碍。提供关于出院时和出院后预期情况的指南，以及专注于授权和协作的实践，将有助于药剂师在老年人护理转接全过程中发挥更大作用。
