Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review

Abstract

Shawn Varghese,1– 3 Shoshana Hahn-Goldberg,1,4 ZhiDi Deng,1 Glyneva Bradley-Ridout,1,5 Sara JT Guilcher,1,6 Lianne Jeffs,6– 8 Craig Madho,4 Karen Okrainec,9 Zahava RS Rosenberg-Yunger,10 Lisa M McCarthy1,2,11,12 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; 2Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada; 3Michael G.Degroote School Of Medicine, McMaster University, Hamilton, Ontario, Canada; 4OpenLab, University Health Network, Toronto, Ontario, Canada; 5Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada; 6Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 7Sinai Health, Toronto, Ontario, Canada; 8Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 9Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada; 10Ted Rogers School of Management, School of Health Services Management, Ryerson University, Toronto, Ontario, Canada; 11Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 12Institute for Better Health, Trillium Health Partners, Mississauga, ON, CanadaCorrespondence: Lisa M McCarthy, Clinician Scientist, Institute for Better Health, Trillium Health Partners, Tel [phone], Email [email protected]: Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings.Methods: Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer.Results: A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers).Conclusion: The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.Keywords: continuity of patient care, patient discharge, patient education, rapid scoping review, medication counseling, care transitions

Keywords

• continuity of patient care
• patient discharge
• patient education
• rapid scoping review
• medication counseling
• care transitions