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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR60

Inpatient pharmaceutical inputs to facilitate seamless care

By S. A. Al-Rashed, D. J. Wright, N. Roebuck*, W. Sunter* and H. Chrystyn

Introduction Educating patients in hospital has been shown to improve their understanding of the importance of continued therapy and compliance at home following discharge.1 Pharmaceutical care plans given to a patient pre-discharge together with counselling improved compliance but did not alter unintentional changes to therapies.2 The use of medication and information discharge summaries (MIDS) has become the standard procedure in many hospitals. This, together with pharmaceutical counselling backed up with simple medicine reminder cards,3 may help with the delivery of seamless care.

Method Ethical committee approval was obtained and all patients gave written informed consent. Control and study patients were randomly recruited from two different care of the elderly wards in the same hospital. Control patients received the standard discharge procedure from a nurse. The study patients received structured counselling (approximately 30 minutes) from a clinical pharmacist, including information about their medication, MIDS and a medicine reminder card. All patients received 14 days of discharge medication and a copy of their MIDS and were informed that someone would visit them two to three weeks later to assess how they were "coping with their medicines" (visit 1). All patients were instructed to show the MIDS to their general medical practitioner (GP) and community pharmacist. They all received pharmaceutical counselling during visit 1 and during visit 2 (three months later). During each visit all pharmaceutical data together with medical events were collected and compliance was evaluated from a tablet count.

Focal points

  • Elderly patients on discharge received either the standard procedure (control) or structured pharmacist counselling and a medicine reminder card (study)
  • All received a medication and information discharge summary (MIDS) describing their admission
  • Compliance and knowledge were better in the study group; unplanned visits to the GP and readmissions were lower in this group
  • Only 5.7 per cent of the patients showed their MIDS to their community pharmacists
  • In-patient pharmaceutical counselling demonstrated positive health outcomes

Results Forty-four control and 45 study patients were discharged with 40 and 43, respectively, completing both visits. Their mean (SD) age was 81.1 (5.8) and 80.2 (5.7) years prescribed 7.1 (2.3) and 7.1 (1.8) items, respectively. A summary of the data from visit 1 and 2 is shown in Table 1.
Table 1

The medication of 26 study and 22 control patients was altered by a doctor prior to visit 1, and 23 and 17 prior to visit 2, respectively. Ten control group patients altered their own medication compared with 2 study patients at visit 1. At visit 2 these reduced to 4 and zero respectively.
Sixty-two point five per cent of GPs replied that they had received the MIDS via the post from the hospital; 39.1 per cent of the GPs indicated that they had been shown the MIDS by their patient but only 5.7 per cent of community pharmacists were shown the MIDS by the patients at visit 1.

Discussion To achieve continuity of discharge procedures to each group, the study and control patients were recruited from different wards, thus complete blinding was not possible. Study group patients demonstrated better knowledge and compliance together with reduced unplanned visits to the doctor and readmissions. Compliance in the study group after the first visit could be due to reinforcing the medicine reminder chart. Counselling patients in the control group at home did improve knowledge but not to the levels achieved in the study group but their (control group) compliance was unaffected.
The results highlight the value of inpatient pharmaceutical counselling and domiciliary visits.

School of pharmacy, University of Bradford, Bradford, BD7 1DP; *pharmacy department, Huddersfield Royal Infirmary, Huddersfield, HD3 3EB

References

1. Oborne A, Dodds L J. Seamless pharmaceutical care: the needs of community pharmacists. Pharm J 1994;253:502-6.
2. Smith L, McGowan L, Moss-Barclay C, Wheater J, Knass D, Chrystyn H. An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital. Brit J Clin Pharmacol 1997;44:163-5.
3. Raynor DK, Booth JG, Blenkinsopp A. Effects of computer generated reminder charts on patient's compliance with drug regimes. Br Med J 1993;306: 1158-61.