J Am Pharm Assoc (2003). 2024 May-Jun;64(3):102076. doi: 10.1016/j.japh.2024.102076. Epub 2024 Mar 26.
Transitions of care (TOC) is the coordination and continuity of health care as a patient transfers between different settings. This can include a wide range of services, such as medication reconciliation, patient counseling, bedside delivery of medications, and others that meet individual patient needs. In the pediatric population, patients are at increased risk of potential medication errors and subsequent harm owing to reduced patient and caregiver health literacy, limited dosage form availability, and errors in medication administration. The use of TOC services at the time of hospital discharge in this population has the potential to make a positive impact on patient safety and the treatment of medical conditions.
The primary objective of this study was to determine whether patient-perceived understanding of home-going medications was greater in patients and/or caregivers who received medication bedside delivery and education from a pharmacy-led TOC service at a large pediatric academic medical center. The secondary objective was to determine whether the primary practice area of the pharmacist providing medication education led to changes in understanding of home-going medication(s).
Using institution-wide, patient satisfaction surveys from January 1, 2021, to December 31, 2021, patient and caregiver responses were queried for 2 questions about home-going medications, relating to the understanding of administration and the potential adverse effects. Patients were divided into 2 groups depending on TOC services received, as documented in the electronic medical record (EMR). Survey responses for each of the 2 questions were categorized as top-box percentage by study group. Hypothesis testing between study groups for the primary and secondary outcomes were conducted using chi-squared tests at an alpha of 0.05. Statistical analyses were conducted using SAS version 9.4.
Of the 1159 patients included in the study, 441 received TOC services, deemed the intervention group, and 718 did not receive TOC services, deemed the control group. When the intervention and control group were asked about understanding of medication administration, 96.37% versus 93.18% of patients (P = 0.007) gave the most favorable response of "yes, definitely," respectively. Furthermore, 78.51% versus 77.44% of patients (P = 0.053) gave the most favorable response when asked about understanding potential medication adverse effects, respectively.
Patients receiving TOC services by a member of the pharmacy team had a greater score for understanding of both medication administration and adverse effects. Furthermore, this greater score was consistent among the education provided by the inpatient and outpatient pharmacist.
医疗过渡（TOC）是指患者在不同医疗机构之间转移时，医疗服务的协调和连续性。这可能包括一系列服务，例如药物重整、患者咨询、床边送药等，以满足患者的个体需求。在儿科人群中，由于患者和照顾者的健康素养较低、药物剂型有限以及给药错误，患者面临潜在的药物错误和随后的伤害的风险增加。在该人群中，在出院时使用 TOC 服务有可能对患者安全和医疗条件的治疗产生积极影响。
本研究的主要目的是确定在大型儿科学术医疗中心接受药房主导的 TOC 服务提供床边送药和教育的患者和/或照顾者，对出院后用药的理解是否更大。次要目的是确定提供药物教育的药剂师的主要执业领域是否导致对出院用药（s）的理解发生变化。
使用 2021 年 1 月 1 日至 12 月 31 日期间的机构范围内患者满意度调查，根据患者对与药物管理和潜在不良反应相关的 2 个出院后药物问题的回答，查询患者和照顾者的回答。根据电子病历（EMR）中的记录，患者分为接受 TOC 服务的两组。通过研究组对每个问题的“顶盒”百分比进行分类。使用 alpha 为 0.05 的卡方检验对主要和次要结果进行研究组间假设检验。使用 SAS 版本 9.4 进行统计分析。
在纳入的 1159 名患者中，441 名接受了 TOC 服务，被认为是干预组，718 名未接受 TOC 服务，被认为是对照组。当干预组和对照组被问及对药物管理的理解时，分别有 96.37%和 93.18%的患者（P=0.007）给出了最肯定的回答“是的，绝对”。此外，当被问及对潜在药物不良反应的理解时，分别有 78.51%和 77.44%的患者（P=0.053）给出了最肯定的回答。
接受药房团队 TOC 服务的患者在药物管理和不良反应的理解方面得分更高。此外，这种更高的分数在住院和门诊药剂师提供的教育中是一致的。
