SEARCHCOHORTclinical trial, observational study

cohort·clinical trial, observational study, internal medicine, family medicine, public health·PMC10584716

A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge

Drug Safety · 11 authors, 8 centres

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TL;DR

This study evaluated a service designed to transfer medication information to community pharmacies for patients with monitored dosage systems after hospital discharge.

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A multi-method evaluation assessed the TCAM service, which facilitates medication information transfer to community pharmacies for patients with Monitored Dosage Systems (MDS) post-discharge. The impact on medication safety was evaluated via a retrospective before-and-after study of 411 patient records across 18 general practices, screened by clinical pharmacists. Limitations include a retrospective data collection method and considerable statistical uncertainty.

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cohort

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clinical trial

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ORIGINAL PAPER

PMC10584716

A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge

Drug Safety

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ABSTRACT

Abstract Background and Objective Medication safety problems are common post-hospital discharge, and an important global healthcare improvement target. The Transfers of Care Around Medicines (TCAM) service was launched by a National Health Service Trust in the North-West of England, initially focusing on patients with new or existing Monitored Dosage Systems (MDS). The TCAM service is designed to enable the prompt transfer of medication information, with referrals made by hospitals at discharge to a named community pharmacy. This study aimed to explore the utilisation and impact of the TCAM service on medication safety. Methods The evaluation included a descriptive analysis of 3033 anonymised patient referrals to 71 community pharmacies over a 1-year period alongside an assessment of the impact of the TCAM service on unintentional medication discrepancies and adverse drug events using a retrospective before-and-after study design. Impact data were collected across 18 general practices by 16 trained clinical pharmacists. Results Most patient referrals (70%, 2126/3033) were marked as ‘completed’ by community pharmacies, with 15% of completed referrals delayed beyond 30 days. Screening of 411 patient records by clinical pharmacists yielded no statistically significant difference in unintentional medication discrepancies or adverse drug event rates following TCAM implementation using a multivariable regression analysis (unintentional medication discrepancies adjusted odds ratio = 0.79 [95% confidence interval 0.44–1.44, p = 0.46]; and adverse drug events adjusted odds ratio = 1.19 [95% confidence interval 0.57–2.45, p = 0.63]), although there remained considerable uncertainty. Conclusions The TCAM service facilitated a number of community pharmacy services offered to patients with monitored dosage systems; but the impact of the intervention on unintentional medication discrepancies and adverse drug event rates post-hospital discharge for this patient group was uncertain. The results of this exploratory study can inform the ongoing implementation of the TCAM service at hospital discharge and highlight the need to understand service implementation in different contexts, which may influence its impact on medication safety. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-023-01342-z.

CITATION EXPORT

Fatema A Alqenae, Douglas Steinke, Hilary Belither et al.. A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge. Drug Safety. (2023). https://doi.org/10.1007/s40264-023-01342-z

AUTHORS

11 · 8 CENTRES

Fatema A Alqenae, Douglas Steinke, Hilary Belither, Peter Robertson, Jennifer Bartlett, Jack Wilkinson, Steven D Williams, Lawrence Brad, Mark Jeffries, Darren M Ashcroft, Richard N Keers

1Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT UK
2Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester UK
3Primary Care Practice, Salford, Manchester UK
4Centre for Biostatistics, Division of Population Health, Health Service Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
5Westbourne Medical Centre, Bournemouth, UK
6NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
7Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
8Division of Population Health, Health Service Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK