European Symposium on Clinical Pharmacy edition:39 location:Lyon date:21-23 October 2010
Seamless care is the desirable continuity of care delivered to a patient in the health care system across the spectrum of caregivers and environments. Despite the desirability of such continuity, patients often experience drug-related problems as a result of discontinuity of care.
The objectives of this study were to summarize Belgian data on drug related problems related to discontinuity of care, as well as initiatives to improve continuity of care focusing on medications.
A combination of three approaches was used: 1) indexed literature search; 2) handsearch of specific Belgian medical and pharmaceutical journals and abstract books of national conferences; 3) grey literature search through a questionnaire survey sent to “experts” in the field.
A high number of recently started heterogeneous projects, mostly initiated in the hospital setting, were inventoried. Many interventions focus on admission, and involve medication history taking by a clinical pharmacist. Patient counselling at discharge, either by a nurse or a clinical pharmacist, is part of many other projects.
For most studies, a positive impact was reported on one or more process measures. The impact on clinical outcomes was evaluated in a few cases only, and could not be demonstrated. Overall, the quality of the evidence is rather low.
Although many studies investigated the frequency and nature of drug related problems on admission as well as discharge, data on the causes of these problems were not identified as such and can only be extrapolated from the studies. Determining factors seem to be the lack of standardization and the involvement of many health care professionals, without clear definition of responsibilities.
Since recently, a variety of types of interventions related to seamless care has been developed. Most interventions were set up in the hospital setting, with an important proportion of initiatives taken by clinical pharmacists.