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Improvement of hospital discharge summary among patients with moderate to severe acute heart failure: Pharmacist –based intervention
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| Author:
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, HELEN FARIS MARZOOG, MANAL KHALID ABDULRIDHA, SHOKRY FAAZ NASSIR
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| Abstract:
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Background: Acute decompensated heart failure keep rising in prevalence and it is an alarming state associated with poor prognosis, re-hospitalization and linked to major mortality and morbidity. Patients with acute heart failure are candidate for medication therapy management since being at high risk for developing adverse drug reaction and medication errors because of poly pharmacy. Accumulating evidence suggests benefits for clinical pharmacists’ participation in intensive care unit (ICU)/coronary care unit (CCU) consultation, and as members of outpatient health-care services.
Objective: Evaluating pharmacist- based management strategies for patients with acute heart failure via improving summary discharge aimed to reducing hospital readmission, enhancing medications adherence and improve quality of life.
Patients and Methods: This prospective study was carried out under intervention pharmacist- based program carried out on 50 patients whom completed this study, they were randomly allocated into two groups, program group(25 patients) who are receiving program for assessment and review starting from 30 minutes pre hospital discharge, then during subsequent post hospital discharge visits that starting with visit 1 (2 weeks), visits 2 (4 weeks), visits 3 (8weeks) and visits 4 (12 weeks). The control group(25 patients) on usual care which was physician based discharge summary and routine lab test without pharmacist intervention. Both study groups assessed for self care heart failure index, patient medications adherence and quality of life. Also laboratory assessment of prognostic biomarkers brain natriuretic peptide and cardiac troponin I and clinical vital signs(BP and HR) and EF were measured pre and post hospital discharge after 12 weeks.
Result: Study findings revealed significant improvement in all self care heart failure index domains score (P=0.001) after 12 weeks post hospital discharge of pharmacist intervention, also increased in domains of belief medication questionnaire whether specific necessity and specific concern domains (P=0.001) or decreased in general harm and general overuse(p=0.001).Moreover, increase in all domains of WHO quality of life questionnaire (WHOQOL) (P=0.001). Both serum brain natriuretic peptide (P=0.001) and cardiac troponin I (P=0.001) level were decreased and ejection fraction was improved (P=0.01). Furthermore, pharmacist intervention and follow up for program patients resulted in reduced hospital readmission (24% vs 60%) and mortality (4% vs 12%) compared to usual care patients respectively.
Conclusion: Implementing pharmacist- based management strategies for patients with acute heart failure via discharge summary markedly improve disease awareness, medication adherence, reduced hospital readmission and total mortality at the study endline among intervention patients compared to the usual care, reflecting the endpoint of the pharmacist-based intervention.
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| Keyword:
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clinical pharmacist, intervention, acute heart failure, re-hospitalization, follow-up, Role.
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| EOI:
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| DOI:
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https://doi.org/10.31838/ijpr/2021.13.02.012
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| Download:
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