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LR30 / The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient counseling and information transfer in Healthcare) on readmission rates in internal medicine department (CRM)

Romania




Type of Patient Safety Practice
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Implementation of patient safety initiatives
Patient safety theme the SCP/clinical risk management practice is aimed at
Clinical risk management (CRM) practice aimed at evaluates the clinical and cost impact of a comprehensive program on continuity of care and associated patient safety [pg.1, 1].
Objective of the CRM practice
Main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient counseling and information transfer in Healthcare) on readmission rates after six months in a multicultural population discharged from the internal medicine department [p2, 1].
Short description of the CRM practice, including any references for further information
COACH program is designed to improve continuity of care combining interventions and using pharmaceutical consultants to perform these interventions. The intervention consists of medication reconciliation at discharge (in addition to medication reconciliation at admission to prevent medication errors from carrying over to the discharge medication), patient counseling at discharge and communication of medication information to the next healthcare providers. At present it is unknown whether such an intervention program indeed can lead to less discontinuity and associated patient harm. The effects between a usual care group and an intervention group (pre- and post-intervention measurement design) are compared. First, patients are included during five months in the usual care group (pre-intervention phase with six months follow-up). Second, the intervention is implemented in the study ward (implementation phase of 3 months). Finally, patients are included during five months in the intervention group (post-intervention phase with six month follow-up) [p2, 1].. Are used exclusion criteria (an estimated proportion of 40% of the patients being excluded due to the exclusion criteria and considering loss to follow-up,) and inclusion (admitted with at least one prescribed drug intended for chronic use) for the patient’s groups. For study of usual care and for intervention were used procedures/protocols to asses: medication reconciliation on admission, medication reconciliation at discharge, patient counseling at discharge and communication of discharge medication.
Innovator of the SCP, country of origin
According to the studies quoted it was implemented in an internal medicine ward of a general teaching hospital in Amsterdam, Netherlands, which serves a multicultural population
Involved health care staff
COACH program is carried out by a team of pharmaceutical consultants (pharmacy technicians trained in pharmacotherapy and communication with patients) with clinical pharmacists as supervisors [p4, 1]. In usual care are involved nurses and residents technicians trained in pharmacotherapy and communication with patients) with clinical pharmacists as supervisors [p4, 1]. In usual care are involved nurses and residents.
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Netherlands/Amsterdam/a general teaching hospital - St. Lucas Andreas Hospital/internal medicine ward [p2, 1].
Summary of evidence for effectiveness, including references
A prospective experimental study is performed at the St. Lucas Andreas Hospital in a 550-bed general teaching hospital serving a multicultural population. The study is carried out from June 2009 through January 2011 [p2, 1]. Previous studies report an absolute decreased readmission rate of 13-30% or 5-9% (median 15%). Based on a conservative interpretation of these studies, it is estimated that the intervention reduces the proportion of readmitted patients in a comparable population with 10% from 25% in the usual care group to 15% in the intervention group. Because the target population in previous studies was limited to elderly patients and the present study also includes younger patients is expected a lower proportion of readmitted patients in both the usual care as the intervention group, because hospital admissions related to medication are less frequent in younger patients compared to elderly. At the internal ward, the proportion of patients younger than 65 years being discharged is about 20%. Given the assumption that no younger patients are readmitted, the proportion of readmitted patients is 20% lower in both groups. The estimated proportions of readmitted patients are 20% in the usual care and 12% in the intervention group. With these proportions, the expected reduction of readmitted patients is 8%. With a type 1 error of 0.05, a power of 80%, and equal sample sizes, a total of 360 patients per group is needed. At the Department of Internal Medicine 150-180 patients are being discharged each month. With an estimated proportion of 40% of the patients being excluded due to the exclusion criteria and considering loss to follow- up, it is expected that the period to evaluate usual care and the intervention will take about five months for each group [p9, 1].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
The study will be able to evaluate the clinical and cost impact of a comprehensive program on continuity of care and associated patient safety, so the possible impact of the COACH program on hospital readmissions will provide insight in the quality of care. The findings from this study will provide information of interest to many stakeholders, including patients, health care managers, policy makers and health care professionals [p10, 1].
Summary of available information on feasibility, including references
Study’s limitations: selection bias is possible as especially ethnic minority groups might not want to cooperate that could lead to failure to reach the recruitment target and could reduce the study’s statistical power; - previous studies have shown mixed results, it is unknown which interventions are effective and how long the follow-up period should be, - as it concerns a monocenter study this may limit generalizability [p10, 1].
Existing implementation tools, including references
Are used protocols at hospital admission’s time and discharge time, validated research tools as quantitative data collection questionnaires for patients (about their adherence to drug treatment (MARS; Medication Adherence Rating Scale), satisfaction with information about medicines (SIMS), and their attitude towards drugs (BMQ; Beliefs about Medicines Questionnaire), but also for health care professionals (satisfaction of GPs and community pharmacies on the patient’s discharge medication). For economic evaluation patient data collection about healthcare utilization and quality of life (EuroQol) (cost-effectiveness estimate and quality of life) [p8, 1]. Hospital patient records, primary care patient records are also used for data collection. The hospital information system is used to register readmissions of the patients in the same hospital. The patient’s general practitioner is asked for readmissions in other hospitals [p6, 1]. An educational material such as leaflets is also used in order to motivate the patients to ask questions about medication.
Potential for/description of patient involvement in the CRM practice, including references
The patient is directly involved, being asked about his past medication, healthcare utilization and quality of life, about patient and family costs of health care, about Adherence to drug treatment and attitude towards drugs. The patient is counseled about his medication and it is given educational materials (leaflets).
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
1] Fatma Karapinar-Çarkit, Sander D Borgsteede, Jan Zoer1, Carl Siegert, Maurits van Tulder, Antoine CG Egberts, Patricia MLA van den Bemt (2010), The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in a multicultural population of internal medicine patients, Karapinar-Çarkit et al. BMC Health Services Research 2010
Reviewer
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Organisation
There is no specified text here
Any additional information on the CRM (e.g. implementation barriers and drivers)
NO
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