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Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling

Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharm...

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Autores principales: Leguelinel-Blache, Géraldine, Dubois, Florent, Bouvet, Sophie, Roux-Marson, Clarisse, Arnaud, Fabrice, Castelli, Christel, Ray, Valérie, Kinowski, Jean-Marie, Sotto, Albert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616785/
https://www.ncbi.nlm.nih.gov/pubmed/26469927
http://dx.doi.org/10.1097/MD.0000000000001805
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author Leguelinel-Blache, Géraldine
Dubois, Florent
Bouvet, Sophie
Roux-Marson, Clarisse
Arnaud, Fabrice
Castelli, Christel
Ray, Valérie
Kinowski, Jean-Marie
Sotto, Albert
author_facet Leguelinel-Blache, Géraldine
Dubois, Florent
Bouvet, Sophie
Roux-Marson, Clarisse
Arnaud, Fabrice
Castelli, Christel
Ray, Valérie
Kinowski, Jean-Marie
Sotto, Albert
author_sort Leguelinel-Blache, Géraldine
collection PubMed
description Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10(−7)). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are essential to improve outpatients’ primary medication adherence. We identified predictive factors of primary nonadherence in order to target the most eligible patients for discharge counseling sessions. Moreover, implementation of discharge counseling could be facilitated by using Health Information Technology to adapt human resources and select patients at risk of nonadherence.
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spelling pubmed-46167852015-10-27 Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling Leguelinel-Blache, Géraldine Dubois, Florent Bouvet, Sophie Roux-Marson, Clarisse Arnaud, Fabrice Castelli, Christel Ray, Valérie Kinowski, Jean-Marie Sotto, Albert Medicine (Baltimore) 3700 Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10(−7)). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are essential to improve outpatients’ primary medication adherence. We identified predictive factors of primary nonadherence in order to target the most eligible patients for discharge counseling sessions. Moreover, implementation of discharge counseling could be facilitated by using Health Information Technology to adapt human resources and select patients at risk of nonadherence. Wolters Kluwer Health 2015-10-16 /pmc/articles/PMC4616785/ /pubmed/26469927 http://dx.doi.org/10.1097/MD.0000000000001805 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3700
Leguelinel-Blache, Géraldine
Dubois, Florent
Bouvet, Sophie
Roux-Marson, Clarisse
Arnaud, Fabrice
Castelli, Christel
Ray, Valérie
Kinowski, Jean-Marie
Sotto, Albert
Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling
title Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling
title_full Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling
title_fullStr Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling
title_full_unstemmed Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling
title_short Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling
title_sort improving patient's primary medication adherence: the value of pharmaceutical counseling
topic 3700
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616785/
https://www.ncbi.nlm.nih.gov/pubmed/26469927
http://dx.doi.org/10.1097/MD.0000000000001805
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