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Project

Exploration of pharmaceutical care services to support adequate medication use in older polymedicated patients in primary care and post-discharge.

Healthcare systems worldwide are struggling to accommodate to the healthcare needs of older patients with polypharmacy, a population that is at high risk for medication misadventures. Drug-related problems and drug-related (re)hospitalizations frequently occur in primary care and are very common post-discharge. Any transition of care puts patients at risk for medication discrepancies, medication errors and drug-related problems.

The overall objective of this PhD research was to develop and evaluate (elements of) two pharmaceutical care services, to be performed by the community pharmacist, to support older polymedicated patients with their medication use. The research consisted of two main projects. 

In the first project we developed and evaluated a medication use review service in the community pharmacy. This research was named SIMENON, an acronym for Studying the Impact of a Medication use EvaluatioN by the cOmmuNity pharmacist.The SIMENON project consisted of a feasibility study and intervention study with a pre-post design. 

In the SIMENON intervention study, 56 Belgian community pharmacists performed a medication use review for 453 patients. A median of 3 drug-related problems per patient were detected. Approximately half of the problems were solved at follow-up. Interprofessional contact was initiated for 38% of patients. The results indicate that medication use reviews are an effective strategy to detect and resolve drug-related problems. The impact of the medication use review service on patient-reported outcome measures and patient-reported experiences was evaluated using a before-after design. The medication use review resulted in reduced medication burden but did not significantly impact the patient’s adherence and number of hospitalizations. We observed no effect on self-management, number of ER visits and fall incidents. Patients were highly satisfied with the service. 

The second projectresearched the problems and solutions related to continuity of care (after hospital discharge) and has provided building blocks for a medication reconciliation service by the community pharmacist. This research was named the DISPATCH project, an acronym for Discharge Information Shared with the Pharmacist concerning Aged patients Transferred to the Community from the Hospital. Three building blocks have been developed as part of this research: (1) information exchange between the hospital and the pharmacy (content development and legal perspectives of information exchange), (2) pharmacist training and (3) medico-pharmaceutical concertations. 

In conclusion, we have demonstrated the potential added value of the community pharmacist in supporting adequate medication use in older polymedicated patients. Furthermore, we hope to have contributed to the future implementation of pharmaceutical care services in Belgium. 

Date:22 Sep 2014 →  30 Apr 2019
Keywords:Pharmaceutical care, community pharmacist, seamless care
Disciplines:Medicinal products, Pharmaceutics, Pharmacology, Pharmacotherapy, Other pharmaceutical sciences
Project type:PhD project