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Pharmacy World & Science

, Volume 32, Issue 5, pp 622–630 | Cite as

Drug related problems after discharge from an Australian teaching hospital

  • Glena R. Ellitt
  • Ellinor Engblom
  • Parisa Aslani
  • Tommy Westerlund
  • Timothy F. ChenEmail author
Research article

Abstract

Objective To reconcile patients’ medicines and to classify drug related problems identified during medication review conducted after discharge from hospital. Setting Patients were discharged from the cardiology unit of Westmead Hospital after recruitment into the Westmead Medicines Project which ran from 2004 to 2007. Method This retrospective study involved an analysis of drugs, diseases and drug related problems in medication review reports available for 76 out of 85 patients who received a Home Medicines Review (HMR). Data sources for medication reconciliation and analyses also included hospital discharge summaries (n = 70) and GP referrals for HMR (n = 44). Comprehensive clinical profiles were constructed for the 76 subjects whose drug related problems were identified, coded, and then classified from their HMR reports. Main outcome measures Number, type, distribution and international classification of drugs, diseases and drug-related problems. Results Patients were prescribed drugs for a broad range of cardiovascular, circulatory, endocrine, respiratory and digestive system diseases. Mean number of drugs per patient in discharge summaries: 8.7 ± SD 3.3 (range 3–19); in GP referrals: 8.9 ± SD 4.3 (range 2–23); and in HMR reports: 10.8 ± SD 4.0 (range 3–24). Mean number of diseases per patient in discharge summaries: 4.1 ± SD 2.9 (range 1–11); and in HMR reports: 4.7 ± SD 2.6 (range 1–12). A total of 398 drug related problems were identified for 71 (93.3%) patients with mean 5.6 ± SD 4.3 problems (range 1–21). The most frequently recorded problems were the patients’ uncertainty about drug aim: n = 128 (32.0%); potential interactions n = 89 (22.4%); and adverse reactions n = 60 (15.1%). Conclusion This study showed that patients recently discharged from a tertiary care hospital had a significant number of drug related problems. Classification of drugs and diseases revealed a broad range of non-cardiovascular medicines and conditions in the patients from an acute care cardiology unit. We found that home medicines review provided continuity of care and an opportunity for medication reconciliation which revealed marked differences in number of drugs, between hospital discharge and medicines review. The patients’ uncertainly about their drugs and their diverse range of co-morbidities indicated the need for timely counselling by pharmacists in the community.

Keywords

Australia Cardiovascular Continuity of care Drug related problems Medication reconciliation Medication review 

Notes

Acknowledgments

The authors would like to thank Mr Kingsley Ng and Ms Elizabeth Anderson from the Department of Pharmacy, Westmead Hospital, Sydney West Area Health Service, NSW Australia, for their commitment in reviewing the HMR reports submitted to the research team.

Funding

The original research project was externally funded as part of the Research and Development Program, Third Community Pharmacy Agreement, managed by the Pharmacy Guild of Australia, and funded by the Australian Government Department of Health and Ageing.

Conflict of interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Roughead EE, Semple SJ. Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008. Aust New Zealand Health Policy. 2009;6:18. doi: 10.1186/1743-8462-6-18.CrossRefPubMedGoogle Scholar
  2. 2.
    Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of home-based intervention on unplanned re-admissions and out-of hospital deaths. J Am Geriatr Soc. 1998;46:174–80.PubMedGoogle Scholar
  3. 3.
    Amabile CM, Spencer AP. Keeping your patient with heart failure safe: a review of potentially dangerous medications. Arch Intern Med. 2004;164:709–20. http://dx.doi.org/10.1001/archinte.164.7.709. Accessed 17 Apr 2009.Google Scholar
  4. 4.
    Lindblad CI, Hanlon JT, Gross CR, Sloane RJ, Pieper CF, Hajjar ER, et al. Clinically important drug-disease interactions and their prevalence in older adults. Clin Ther. 2006;28:1133–43. http://dx.doi.org/10.1016/j.clinthera.2006.08.006. Accessed 17 Apr 2009.Google Scholar
  5. 5.
    Paulino EI, Bouvy ML, Gastelurrutia MA, Buurma H, ESCP-SIR Rejkjavik Community Pharmacy Research Group. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26:353–60.PubMedGoogle Scholar
  6. 6.
    de Koning JS, Klazinga NS, Koudstaal PJ, Prins A, Dippel DW, Heeringa J, et al. Quality of care in stroke prevention: results of an audit study among general practitioners. Prev Med. 2004;38:129–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Fekete EM, Antoni MH, Schneiderman N. Psychosocial and behavioural interventions for chronic medical conditions. Curr Opin Psychiatry. 2007;20:152–57. doi.org/ 10.1097/YCO.0b013e3280147724.
  8. 8.
    Hovell MF, Geary DC, Black DR, Kamachi K, Kirk R, Elder J. Experimental analysis of adherence counseling: implications for hypertension management. Prev Med. 1985;14:648–54.CrossRefPubMedGoogle Scholar
  9. 9.
    Molloy GJ, Perkins-Porras L, Strike PC, Steptoe A. Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome. Health Psychol. 2008;27:52–8. http://dx.doi.org/10.1037/0278-6133.27.1.52. Accessed 17 Apr 2009.
  10. 10.
    Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003;18:201–5. http://dx.doi.org/10.1016/j.jcrc.2003.10.001. Accessed 17 Apr 2009.Google Scholar
  11. 11.
    Ellitt GR, Brien J-aE, Aslani P, Chen TF. Quality patient care and pharmacists’ role in its continuity—a systematic review. Ann Pharmacother. 2009;43:677–91. doi: 10.1345/aph.1L505.CrossRefPubMedGoogle Scholar
  12. 12.
    Dunbar SB, Mensah GA, Labarthe DR, Dunbar SB, Mensah GA, Labarthe DR. Building bridges: a partnership between professional nursing and the centers for disease control and prevention to reduce the burden of heart disease and stroke. Am J Prev Med. 2005;29:122–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30:205–11. doi.org/ 10.1093/ageing%2F30.3.205.Google Scholar
  14. 14.
    MacRae F, Lowrie R, Maclaren A, Barboue RS, Norrie J. Pharmacist-led medication review clinics in general practice: the views of Greater Glasgow GPs. Int J Pharm Pract. 2003;11:199–208. http://dx.doi.org/10.1211/0022357022647.Google Scholar
  15. 15.
    Australian Government Medicare Australia. Home medicines review (HMR). http://www.medicareaustralia.gov.au/provider/pbs/fourth-agreement/hmr.jsp#N1007B (2009). Accessed 30 Jun 2009.
  16. 16.
    Emblen G, Miller E. Home medicines review. Aust Fam Physician. 2004;33:49–51.PubMedGoogle Scholar
  17. 17.
    Pharmacy Guild of Australia. Quality use of medicines (QUM) collaborative report. 2007. http://www.guild.org.au/uploadedfiles/Medication_Management_Reviews/Overview/QUM_Collaborative_report.doc (2009). Accessed 14 Jun 2009.
  18. 18.
    Latif A, Boardman H. Community pharmacists’ attitudes towards medicines use reviews and factors affecting the numbers performed. Pharm World Sci. 2008;30:536–43. doi: 10.1007/s11096-008-9203-x.CrossRefPubMedGoogle Scholar
  19. 19.
    Chabot I, Moisan J, Gregoire JP, Milot A. Pharmacist intervention program for control of hypertension. [see comment]. Ann Pharmacother. 2003;37:1186–93. doi.org/ 10.1345/aph.1C267.
  20. 20.
    Northern Health and Social Services Board PrescribingAdvisors. A guide to patient medication review. 2003. http://www.nhssb.n-i.nhs.uk/prescribing/documents/Guide.pdf (2009). Accessed 29 Jun 2009.
  21. 21.
    Westerlund LOT, Björk HT. Pharmaceutical care in community pharmacies: practice and research in Sweden. Ann Pharmacother. 2006;40:1162–9. http://dx.doi.org/10.1345/aph.1G680. Accessed 17 Apr 2009.
  22. 22.
    Chen TF, Brien JE, Whitehead P, Ng K, Ellitt GR. From hospital to community: a multidisciplinary “continuity of care” model for cardiovascular patients involving community pharmacists. Funded projects, Research and Development Grants Program 2005. http://www.guild.org.au/research/funded_projects.asp (2009). Accessed 24 Jun 2009.
  23. 23.
    Pharmacy Guild of Australia. Home medicines review and medication management review. 2008. http://www.guild.org.au/mmr (2009). Accessed 14 Jun 2009.
  24. 24.
    van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. [see comment]. Ann Pharmacother. 2004;38:859–67. http://dx.doi.org/10.1345/aph.1D182. Accessed 17 Apr 2009.
  25. 25.
    Westerlund T, Almarsdóttir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7:40–50.Google Scholar
  26. 26.
    World Health Organisation. International classification of diseases version 10 (ICD-10). http://www.who.int/classifications/icd/en (2009). Accessed 2 Jul 2009.
  27. 27.
    World Health Organisation. The anatomical therapeutic chemical classification system with defined daily doses (ATC/DDD). http://www.who.int/classifications/atcdd/en (2009). Accessed 1 Jul 2009.
  28. 28.
    Letrilliart L, Hanslik T, Biour M, Fagot JP, Guiguet M, Flahault A. Post discharge adverse drug reactions in primary care originating from hospital care in France: a nationwide prospective study. Drug Saf. 2001;24:781–92.CrossRefPubMedGoogle Scholar
  29. 29.
    Vinks TJAM, deKoning FHP, deLange TM, Egberts TCG. Identification of potential drug-related problems in the elderly: the role of the community pharmacist. Pharm World Sci. 2006;28:33–38. http://dx.doi.org/10.1007/s11096-005-4213-4. Accessed 17 Apr 2009.
  30. 30.
    Hamdy RC, Moore SW, Whalen K, Donnelly JP, Compton R, Testerman F, et al. Reducing polypharmacy in extended care. South Med J. 1995;88:534–8.PubMedGoogle Scholar
  31. 31.
    Bernsten C, Bjorkman I, Caramona M, Crealey G, Frokjaer B, Grundberger E, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging. 2001;18:63–77.CrossRefPubMedGoogle Scholar
  32. 32.
    Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Medication reviews in the community: results of a randomized, controlled effectiveness trial. [erratum appears in Br J Clin Pharmacol. 2005;59(3):376]. Br J Clin Pharmacol. 2004;58:648–64. http://dx.doi.org/10.1111/j.1365-2125.2004.02220.x. Accessed 17 Apr 2009.
  33. 33.
    Sturgess IK, McElnay JC, Hughes CM, Crealey G. Community pharmacy based provision of pharmaceutical care to older patients. Pharm World Sci. 2003;25:218–26.CrossRefPubMedGoogle Scholar
  34. 34.
    Bell JS, Whitehead P, Aslani P, McLachlan AJ, Chen TF. Drug-related problems in the community setting: pharmacists’ findings and recommendations for people with mental illnesses. Clin Drug Investig. 2006;26:415–25. http://dx.doi.org/10.2165/00044011-200626070-00003. Accessed 17 Apr 2009.

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Glena R. Ellitt
    • 1
  • Ellinor Engblom
    • 2
  • Parisa Aslani
    • 1
  • Tommy Westerlund
    • 2
    • 3
  • Timothy F. Chen
    • 1
    Email author
  1. 1.Faculty of Pharmacy A15The University of SydneySydneyAustralia
  2. 2.Sahlgrenska Academy, Institute of Medicine, Department of Public Health and Community MedicineUnit of Social Medicine, University of GothenburgGöteborgSweden
  3. 3.Research and DevelopmentApoteket ABHelsingborg and StockholmSweden

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