Title: International overview of initiatives to promote continuity of care
Authors: Claeys, Coraline
Foulon, Veerle
De Winter, Sabrina
Spinewine, Anne
Issue Date: Oct-2010
Conference: European Symposium on Clinical Pharmacy edition:39 location:Lyon date:21-23 October 2010
Abstract: Introduction:
Medication management is an essential component of continuity of care. Patients’ transition between hospital and community is a high-risk period for the occurrence of drug-related problems [1, 2]. These problems are the subject of growing concern around the world. The objectives of this study were (1) to make an overview of initiatives that have been implemented in 7 selected countries at regional or national levels and that aim at improving continuity of care focusing on medications and (2) to synthesize the factors contributing to the success and failure of these systems.
Materials & Methods:
A structured search of relevant websites was performed for each selected country (Australia, Canada, Denmark, France, The Netherlands, UK, US). Selection of countries was based on the observation, from a systematic literature review, that seamless care initiatives had been developed in these countries. In a first round, a list of the titles and sources of relevant information was shared with experts identified in each country to confirm representativity of the information and to add references. In a second round, a structured description of the initiatives implemented in each country was performed and validated by experts.

Initiatives have been identified in all selected countries. Most initiatives have been implemented since the early 2000 and are still ongoing.
The principal actions include: the development and implementation of guidelines for healthcare professionals (HCPs), national information campaigns, education of HCPs, and the development of information technologies (IT) as to share patient and prescription data between settings of care.
All approaches involved different healthcare professionals from different settings of care (ambulatory and hospitals).
Positive results have been reported in terms, for example, of intake into practice, or number of medication discrepancies. However, additional data are needed to confirm their impact on relevant clinical, economic and humanistic outcome measures.
Critical success factors identified are: requirement of leadership to convey national and local forces and commitment, the adaptation of initiatives to local settings, the development of a regulatory framework (accreditation system, financial penalties), and IT support.
Contributing failure factors identified are: lack of human and financial resources, questions relative to responsibility and accountability of HCPs, lack of training of HCPs, difficulties in agreeing on solutions to guarantee data security and confidentiality.
Discussion / Conclusion
A various set of initiatives were implemented in selected countries. Although not all initiatives are applicable as such to a particular healthcare setting, most of them convey very interesting data that should be used when drawing recommendations for optimizing continuity of care. Critical success and contributing failure factors should be taken into consideration. Their feasibility should be explored in a broad spectrum of HCPs and stakeholders.

1. Tam, V.C., et al., Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ, 2005. 173(5): p. 510-5.
2. Coleman, E.A., et al., Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med, 2005. 165(16): p. 1842-7.
Publication status: accepted
KU Leuven publication type: IMa
Appears in Collections:Research Centre for Pharmaceutical Care and Pharmaco-economics (-)
Clinical Pharmacology and Pharmacotherapy

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