Implementation analysis of an intervention of medication transitions of care for older adults

Mise en contexte : Les effets indésirables médicamenteux contribuent jusqu’à 30 % des hospitalisations chez les aînés, dont la moitié pourrait être évitée. Les transitions adéquates de soins pharmaceutiques entre l’hôpital et le milieu communautaire menées par les pharmaciens ont été associées à une diminution des hospitalisations évitables. Peu de données sont disponibles sur les conditions optimales à leur implantation. Objectif : L’étude vise à analyser l’implantation d’une intervention de transition de soins pharmaceutiques chez les aînés à risque de problèmes liés aux médicaments dans un contexte québécois. L’objectif de cette étude est de décrire les principales caractéristiques de l’intervention et d’en identifier les facilitateurs et les barrières à l’implantation. Méthode : Un devis d’étude de cas unique comprenant l’implantation d’une intervention de transition de soins pharmaceutiques à Magog, Québec a été privilégié. Un échantillonnage par convenance parmi les professionnels impliqués dans l’intervention a été effectué. Les données sont issues de dix entretiens semi-dirigés individuels menés auprès de ces professionnels et de sources écrites documentant le processus d’implantation. L’analyse a été effectuée à partir d’un arbre de codage mixte fondé sur le cadre conceptuel d’implantation de Damschroder. Résultats : Les principales caractéristiques de l’intervention sont : 1) la collaboration interdisciplinaire et la clarté de rôles des professionnels impliqués; 2) le temps dédié à l’intervention et; 3) la bonification des mécanismes de communications interdisciplinaires. Les facilitateurs de l’implantation incluent la disponibilité des leaders et champions cliniciens, la perception et la collaboration des professionnels. Les barrières comprennent la difficulté d’intégration de l’intervention aux soins usuels à l’égard du temps et des ressources, l’adoption d’un dossier médical électronique et le manque d’expertise et la difficulté d’accès à certains patients pour réaliser les suivis. Conclusion : L’analyse des caractéristiques principales de l’intervention ainsi que des facilitateurs et barrières à son implantation démontrent la faisabilité de cette intervention pharmaceutique. Nos résultats mettent toutefois en lumière les enjeux associés à son intégration aux soins usuels dans le système de santé québécois. L’implantation de l’intervention dans différents contextes en permettra une évaluation plus exhaustive.Abstract: Background: Adverse drug reactions contribute to 30 % of hospitalization incidents among older adults and half of these incidents could be avoided. Pharmacist-led transitions of care between hospital and community settings have been associated with decreased hospitalizations. Few data are available on the optimal conditions for their implantation. Purpose of research: The study aims to analyze the implementation of a pharmacist-led transition of care intervention among older adults with drug-related problems in a milieu of the Quebec health system. The objectives of this study are to describe the main characteristics of the intervention and to identify the facilitators and the barriers to its implementation. Methods: A single case study design including the implementation of a pharmacist-led transition of care intervention in Magog, Quebec was preferred. A convenience sampling of the professionals involved in the intervention was used. Data were gathered through ten semi-structured individual interviews conducted with these professionals and the written sources documenting the implementation process. The analysis was conducted using a mixed coding matrix based on Damschroder's conceptual implementation framework. Results: The main characteristics of the intervention are the interdisciplinary collaboration and clarity of the involved professional’s roles, the time dedicated to the intervention and the improvement of interdisciplinary communication mechanisms. The implementation facilitators include the availability of leaders and clinical champion, as well as the perception and collaboration of professionals. The Barriers include the limitations in integrating the intervention into routine care in terms of time and resources, an electronic medical record adoption and the lack of skills and the difficult access to some patients for the follow-ups. Conclusion: The analysis of the main characteristics of the intervention, the facilitators and the barriers to its implementation demonstrate the feasibility of this pharmacist-led transition of care intervention. However, our results highlight the issues associated with its integration into routine care in the Quebec health system. The implementation of the intervention in different regions will allow a more extensive assessment

Pharmacist-led transitions of care for older adults at risk of drug-related problems : a feasibility study

Background: Transitions of care (TOC) is one of three key action areas identified in the World Health Organization (WHO)’s third Global Patient Safety Challenge, Medication Without Harm, released in 2017. Systematic reviews have shown that TOC interventions can improve health outcomes, although few studies have evaluated the role of the community pharmacist. Objective: To evaluate the feasibility of a pharmacist-led TOC intervention for older adults at risk of drug-related problems. Methods: Pragmatic feasibility study conducted in hospital and community pharmacies in a health region of Quebec, Canada. The interventions consisted of a pharmaceutical care plan developed by the hospital pharmacist and transferred at hospital discharge to the patients’ community pharmacist, who completed patient consultations in the week following discharge and monthly for six months thereafter. Feasibility evaluations included recruitment, retention, time required, types of interventions, and modified classes of medications, based on clinical data entered in an electronic health record accessible to clinicians in all settings. Results: Of the 90 recruited patients, 76 were discharged with a pharmaceutical care plan. The mean age of these 76 subjects was 79.5 years, and 52.6% were female. The most frequent inclusion criteria were 15 or more medications (57.9%), two or more emergency department visits (past three months), or one or more hospitalization (past twelve months) (42.1%). The hospital pharmacist interventions took a mean time of 222 min. The community pharmacist interventions took a mean time of 52 min and 32 min for the first and subsequent visits, respectively. Therapeutic goals were documented for 60.5% of patients. Conclusions: This study shows the feasibility of implementing a pharmacist-led TOC intervention in the Canadian context. Development of the TOC model in three health regions is currently being pursued along with the inclusion of primary care clinics who recently added pharmacists to their interdisciplinary teams