Seamless care focusing on medications

Transcription

1 Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d expertise des soins de santé Belgian Health Care Knowledge Centre Seamless care focusing on medications Anne Spinewine, Veerle Foulon, Coraline Claeys, Jan De Lepeleire, Pierre Chevalier, Franciska Desplenter, Sabrina De Winter, Christophe Dumont, Valérie Lacour, Steven Simoens, Cécile Dubois, Dominique Paulus Veerle Foulon and Anne Spinewine

2 Seamless care = Background The desirable continuity of care delivered to a patient in the health care system across the spectrum of caregivers and environments Focus on Medications transition between the hospital setting and ambulatory setting 2

3 Background (2) Drug related problems as a result of discontinuity of care: literature data Upon admission, at least one error in medication history for 27% 54% of patients 63,7% of patients discharged from hospital experience drug related problems 60% of unplanned re-admissions of elderly people could be avoided by a more efficient intervention at discharge from the hospital 3

4 Aim To propose a system to improve continuity of care with regard to medications, on admission as well as at discharge from the hospital by analyzing international and Belgian data 4

5 International data Methods Systematic literature review on impact and costeffectiveness of initiatives Initiatives abroad: national or regional levels Belgian data Belgian initiatives: summary of data on drug related problems and initiatives to improve continuity of care Medication changes after discharge of hospital: IMA data Qualitative study: perception of HCPs on approaches to improve seamless care 5

6 Qualitative study 2 sets of focus groups: 9 focus groups with health care professionals / patients 2 focus groups with stakeholders Discussions were tape recorded, transcribed and analyzed using a thematic framework approach 6

7 Qualitative study Date Location Language Participants 16/12/2009 Charleroi French HCPs 16/12/2009 Ieper Dutch HCPs 05/01/2010 Duffel Dutch HCPs 07/01/2010 Eeklo Dutch HCPs 08/01/2010 Ottignies French HCPs 14/01/2010 Liège French HCPs 15/01/2010 Genk Dutch HCPs 21/01/2010 Libramont French HCPs 28/01/2010 Brussels Dutch/French HCPs 02/02/2010 Brussels Dutch/French Stakeholders 04/02/2010 Brussels Dutch/French Stakeholders 7

8 Problems identified Problems on hospital admission: e.g. incomplete list of medicines, absence of information in case of emergency admission ; Problems at hospital discharge: e.g. patient not (sufficiently) informed, lack of communication with general practitioner, insufficient supplies of medicines for the weekend; Problems linked to health care professionals: e.g. GP s opinion different to that of the specialized physician, lack of assistance to the patient with regard to medicines management; Problems linked to patients and families: e.g. failure to understand treatment, non-compliance; Problems linked to the process: e.g. documents difficult to read, substitutions by HCPs. 8

9 Solutions: goals to achieve Accurate medication history Assessment of current medication management Medication action plan Supply of medicines information to patients Ongoing access to medicines Communicating medicines information

10 Solutions: key elements a national information campaign; an up-to-date (paper-based or electronic) medication list / plan; FG3/HN: At home you don t have anything. I should already be pleased when it is on paper. FG7/CC: It would be easier if all schemes would be the same (any hospital, any department) a comprehensive discharge file; FG8/SP: So really a report from the hospital pharmacist, for the community pharmacist, documents for the patient and for the physician. The home nurse and others need access to the medical information. 10

11 Solutions: key elements a centralized national electronic patient file including medical, pharmaceutical, care and social information; FG3/DM: We need an extramural electronic file so we don t need to be a detective. electronic prescribing; reimbursement for assisting patients in their medication management; FG8/SS: For patients, whose cognitive functions are impaired, someone has to prepare medications at home but this is not included in the nomenclature of nurses. 11

12 Solutions: key elements therapeutic education for patients; FG5/P: Information of the patient is the most important: you can automate everything you want, if you do not convince me of the relevance of the medication I do not take the medication. clinical pharmacy, FG8/SP: We need the expertise of a clinical pharmacist. local consultation to enhance cooperation between settings of care and HCPs, coordination of medication management FG7/P: The GP should be a central and also an intermediary person. Much more communication is needed. 12

13 Solutions: general remarks need for a comprehensive package of solutions need for responsibility on the part of the various care providers involved GP often mentioned as the most appropriate health care provider for coordination in medication management agreement on the necessity of seamless care with regard to medications for every patient. vulnerable groups requiring special attention: geriatric patents, patients with a psychiatric profile, patients on poly-medication. 13

14 jdl2 Feasibility of proposed solutions? 14

15 Slide 14 jdl2 gaat ge mijne krabbel echt tonen? u ; 17/09/2010

16 Barriers and facilitators Barriers privacy, lack of standardization, lack of the willingness to change, lack of time to proceed with the solutions, (professional) resistance at all levels, accessibility of the solutions (standardised, supported and adequately implemented technical solutions). 15

17 Barriers and facilitators Facilitators ongoing projects, fast development of IT solutions, supposed added clinical value of the proposed interventions 16

18 Conclusions Important problems exist as to medications at transition moments. The involved healthcare professionals identified feasible and desirable solutions, that are multifaceted and multileveled, incorporating the input of many professionals and organisations. 17

19 How does this fit in with international data? Building blocks to optimize seamless care 3 levels: - Policy level - Health care professional level - Patient level 18

20 Building blocks Policy level National guidelines National campaign Financial / regulatory incentives Financing specific services Electronic health care infrastructure Tuned regulations Agreement on target patients Research 19

21 Building blocks Health care professional level Intermediate level of coordination Involvement, responsibility and accountability 20

22 Building blocks Patient level On admission: medication history taking and medication reconciliation At discharge: timely, structured and comprehensive information; appropriate medication supply After discharge: reinforcement of information and reconciliation Availability of an accurate medication plan for each patient, accessible for each HCP involved Local consultation to enhance cooperation 21

23 BIJ OPNAME: Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d expertise des soins de santé Belgian Health Care Knowledge Centre Combinatie van verschillende informatiebronnen en gebruik van gestandaardiseerde procedures voor medicatiebevraging NA ONTSLAG: versterken van de informatie, en toepassen van een procedure voor het op elkaar afstemmen van de theoretische behandeling en wat de patiënt effectief neemt; («reconciliation procedure») Beschikbaarheid, voor elke patiënt, van een geneesmiddelenlijst (bij voorkeur ook in elektronisch formaat), toegankelijk voor de betrokken zorgverstrekkers BIJ ONTSLAG: - tijdige, gestructureerde en volledige informatie aan patiënten en zorgverstrekkers van de eerste lijn - voldoende voorraad geneesmiddelen om de periode vóór de mogelijke aankoop van geneesmiddelen te overbruggen

24 Thanks to: all who responded to the survey all who participated in focus groups Contact: Anne Spinewine Veerle Foulon Full report at www. 23