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4CPS-067 A cross-sectoral pharmacist intervention for patients in transition between hospital and general practice: a pilot study
  1. CA Sørensen1,
  2. L Jeffery2,
  3. J Falhof3,
  4. P Harbig4,
  5. K Roelsgaard5,
  6. S Gram6,
  7. C Olesen1
  1. 1Hospital Pharmacy Central Denmark Region, Research and Development- Clinical Pharmacy, Aarhus N, Denmark
  2. 2Hospital Pharmacy Central Denmark Region, Clinical Pharmacy, Silkeborg, Denmark
  3. 3General Practice, Laegefaellesskabet, Grenaa, Denmark
  4. 4Aarhus University, Public Health, Aarhus, Denmark
  5. 5Randers Regional Hospital, Medical Department, Randers, Denmark
  6. 6Randers Regional Hospital, Administration, Randers, Denmark


Background and Importance Drug-related problems (DRPs) in cross-sectoral transitions are often seen, primarily due to inconsistent information about patients‘ medicines at transfer.

Aim and Objectives To test a cross-sectoral pharmacist intervention for patients in healthcare transitions.

Material and Methods The study was performed in one hospital and four General Practices (GPs). The pharmacists had shared employment between the Hospital Pharmacy and the GPs.

Transition GP to Hospital

Medication history, medication reconciliation, updating the Shared Medication Record (SMR).

Transition Hospital to GP

Medication review, overview of medication changes, follow-up telephone calls, communication with GP on DRPs.

The intervention was tested in one GP and evaluated descriptively.

Afterwards, the intervention was tested in four GPs with differing characteristics and evaluated qualitatively (semi-structured interviews).

Results Test in one GP:

Transition GP to Hospital (n=14)

The GP updated the SMR in 86% of patients. The medication history revealed discrepancies between SMR-prescriptions and actual medication intake in 64% of these patients; 91% of discrepancies were easily solved by correcting the SMR.

Transition Hospital to GP (n=30)

Hospital medication changes occurred in 79% of patients; 71% were communicated to the GP and 42% to homecare nurses.

Medication reviews revealed 55 DRPs in 67% of patients, mostly related to medication reconciliation, dose or interactions.

Follow-up telephone calls on 23 patients revealed DRPs in 30% of these.

Test in four GPs:

Seven interviews were performed – one per GP, three with the pharmacists involved (mean 71 minutes).

Clinical staff had positive attitudes towards the intervention and saw the advantages of a pharmacist with a shared employment. Economics were identified as a barrier for future implementation.

Pharmacists in smaller GP clinics had easier access to clinicians and felt a more integrated member of the team.

The larger clinics were more structured and used to interdisciplinary collaboration, allowing the pharmacist more freedom to work independently.

Conclusion and Relevance GPs had little focus on updating the SMR prior to admission. Medication changes and follow-up plans were not always communicated to the patient, GP or homecare at discharge.

Shared employment with unique access to health records in both sectors was the most important tool in identification and resolution of DRPs.

The intervention was transferable to other GPs and was considered acceptable and relevant by all.

Conflict of Interest No conflict of interest

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