Pharmacist-led interventions during transitions of care of older adults admitted to short term geriatric units: Current practices and perceived barriers

Véronique C LeBlanc; Audrey Desjardins; Marie-Pier Desbiens; Christine Dinh; Fanny Courtemanche; Faranak Firoozi; Suzanne Gilbert; Yola Moride; Yannick Villeneuve

doi:10.1016/j.rcsop.2021.100090

Pharmacist-led interventions during transitions of care of older adults admitted to short term geriatric units: Current practices and perceived barriers

Explor Res Clin Soc Pharm. 2021 Nov 17:5:100090. doi: 10.1016/j.rcsop.2021.100090. eCollection 2022 Mar.

Authors

Véronique C LeBlanc^{1

2}, Audrey Desjardins^{1

2}, Marie-Pier Desbiens^{1

2}, Christine Dinh^{1

2}, Fanny Courtemanche³, Faranak Firoozi^{3

4}, Suzanne Gilbert^{3

4}, Yola Moride¹, Yannick Villeneuve^{3

4}

Affiliations

¹ Faculty of Pharmacy, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada.
² Department of Pharmacy, Jewish General Hospital, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, 3755 Côte-Sainte-Catherine Rd, Montreal, Quebec H3T 1E2, Canada.
³ Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565 Queen Mary Rd, Montreal, Quebec H3W 1W5, Canada.
⁴ Research Center, Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4545 Queen Mary Rd, Montreal, Quebec H3W 1W6, Canada.

Abstract

Background: During transitions of care, older adults are at risk of adverse drug events which could lead to avoidable hospital visits. Pharmacists are increasingly involved in care teams at various stages of the continuum of care. The types and frequency of clinical interventions performed by pharmacists in the geriatric practice setting remain poorly documented.

Objectives: This study aimed to describe the current integration of pharmacist interventions during transitions of care of older adults admitted in short-term geriatric units (STGUs) and to explore barriers and facilitators to their implementation in clinical practice. The secondary objective was to explore associations between certain patient characteristics and pharmacist-led interventions during transitional care.

Methods: A mixed methods study was conducted with pharmacists practicing in STGUs in the Montreal area, Canada. The application of 8 pharmaceutical interventions was assessed using a self-administered questionnaire, along with as a retrospective chart review. Four semi-structured group interviews were conducted in order to identify perceived barriers and facilitators.

Results: Thirteen pharmacists participated in the study. In the questionnaire, medication reconciliation on admission and at discharge was reported as being performed at least half the time by 12 (92%) and 7 (54%) pharmacists, respectively. The retrospective chart review revealed that these interventions were documented in 95 (98%) and 25 (26%) files, respectively. While 35% of patients had a documented pharmaceutical care plan on admission, none was documented at discharge. Several barriers to implementing clinical interventions were identified such as lack of time, technical support, communication and standardization.

Conclusions: Pharmacists are involved at different periods of transitional care; however, certain barriers should be addressed in order to expand their role in discharge planning. Providing guidelines on what is expected at discharge and post-discharge, and having a practice focused on delegation and collaboration would help pharmacists increase their role throughout the transition of care of older adults.

Keywords: Barriers; Clinical practice; Older adult; Pharmacist; Pharmacy; Transitions of care.