Author:
Allan Julaine,Nott Shannon,Chambers Brett,Hawthorn Ged,Munro Alice,Doran Chris,Oldmeadow Chris,Coleman Clare,Saksena Teesta
Abstract
Abstract
Background
Medication errors are a leading cause of mortality and morbidity. Clinical pharmacy services provided in hospital can reduce medication errors and medication related harm. However, few rural or remote hospitals in Australia have a clinical pharmacy service. This study will evaluate a virtual clinical pharmacy service (VCPS) provided via telehealth to eight rural and remote hospitals in NSW, Australia.
Methods
A stepped wedge cluster randomised trial design will use routinely collected data from patients’ electronic medical records (n = 2080) to evaluate the VCPS at eight facilities. The sequence of steps is randomised, allowing for control of potential confounding temporal trends. Primary outcomes are number of medication reconciliations completed on admission and discharge. Secondary outcomes are length of stay, falls and 28 day readmissions. A cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) will be conducted. The CEA will answer the question of whether the VCPS is more cost-effective compared to treatment as usual; the CBA will consider the rate of return on investing in the VCPS. A patient experience measure (n = 500) and medication adherence questionnaire (n = 100 pre and post) will also be used to identify patient responses to the virtual service. Focus groups will investigate implementation from hospital staff perspectives at each site.
Analyses of routine data will comprise generalised linear mixed models. Descriptive statistical analysis will summarise patient experience responses. Differences in medication adherence will be compared using linear regression models. Thematic analysis of focus groups will identify barriers and facilitators to VCPS implementation.
Discussion
We aim to demonstrate the effectiveness of virtual pharmacy interventions for rural populations, and inform best practice for using virtual healthcare to improve access to pharmacy services. It is widely recognised that clinical pharmacists are best placed to reduce medication errors. However, pharmacy services are limited in rural and remote hospitals. This project will provide evidence about ways in which the benefits of hospital pharmacists can be maximised utilising telehealth technology. If successful, this project can provide a model for pharmacy delivery in rural and remote locations.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR) -ACTRN12619001757101 Prospectively registered on 11 December 2019. Record available from: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378878&isReview=true
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny M, Sheikh A, Medication without Harm: WHO’s third Global Patient Safety Challenge, Lancet, 2017;389: 1680–1681. doi: https://doi.org/https://doi.org/10.1016/S0140-6736(17)31047-4.
2. Australian Commission on Safety and Quality in Health Care. High 5s project assuring medication accuracy at transitions of care – Australian interim report January 2010–march 2013. Sydney: ACSQHC; 2014.
3. Duguid M, Gibson M, O'Doherty R. Review of discharge prescriptions by pharmacists integral to continuity of care [letter]. J Pharm Pract Res. 2002;32:94–5.
4. England NHS. Transformation of seven day clinical pharmacy services in acute hospitals. London: NHS; 2016.
5. Tong EY, Roman CP, Mitra B, Yip GS, Gibbs H, Newnham HH, Smit DV, Galbraith K, Dooley MJ. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust. 2017;206(1):36–9. https://doi.org/10.5694/mja16.00628.
Cited by
9 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献