Objective: After analysing the effectiveness in the reduction in the incidence of functional impairment and a higher probability of returning home between elderly patients hospitalised due to an acute medical illness cared for in acute geriatric units (AGU) compared to conventional care units, we propose to assess the efficiency of this care. Material and methods: A systematic review and meta-analysis was made of controlled studies (randomised, no randomised and case-control) that compared care in UGA with care in conventional hospital units of patients of 65 years and over with an acute medical illness. Studies on administrative data bases, those that evaluated care of a single disease, and those that assessed units with care in the acute and sub-acute phase were excluded. A literature review was performed on articles published up to 31st of August 2008 in Medline, Embase, Cochrane Library, and references of systematic reviews and reviewed

/pdf/revista-espanola-de-geriatria-y-gerontologia-210ysztotd.pdf

Revista Española de Geriatría y Gerontología

Background One of the strategies to promote patient safety in care transitions is medication reconciliation (MR), which is conducted by the pharmacist at the patient's discharge from hospital. However, there are divergences about this process and about the pharmacist's role in conducting such intervention. Objective To systematically review the literature that reports the MR process led by pharmacists at patient discharge and map the different methods, strategies and tools used in the process. Methods Relevant studies were searched in the following databases: EMBASE, MEDLINE (PubMed), The Cochrane Library, and LILACS. No language restriction or publication date was applied. The studies considered eligible were those involving and describing pharmacist-led MR processes at acute patient discharge from hospital, with an experimental, quasi-experimental, or observational design. The characteristics of the studies and the MR processes were identified and then a qualitative synthesis was performed. Results Fifty studies were included. The majority of them were observational ones (82%), and the main outcome was medication discrepancies (42%). The studies were mostly conducted in university hospitals (70%) and in internal medicine wards (54%). Pharmacists were responsible mainly for gathering medication histories (72%), and identifying (96%) and solving (98%) pharmacotherapeutic problems. The main sources of information on pre-admission medications were patient/caregiver interviews (66%) and records from other care providers (40%). Only 30% of the studies described a patient discharge plan, and 14% shared information of the patient's pharmacotherapy with community pharmacists. Conclusion The concept of MR and the pharmacist-led activities in the process varied in the literature, as well as the pharmacotherapy assessment focus and the communication strategies towards patients and other care providers, showing that standardization of the process and concepts is necessary.

Pharmacist-led medication reconciliation at patient discharge: A scoping review.

Intervención farmacéutica al alta hospitalaria para reforzar la comprensión y cumplimiento del tratamiento farmacológico

Resultados de la integración de la atención farmacéutica en una Unidad de Agudos de Geriatría

Objetivo: 

Demostrar que la planificacion anticipada y estructurada del alta del paciente optimiza el proceso de Alta Hospitalaria del centro sanitario, mejorando la organizacion de los servicios asistenciales y adelantando la hora de salida del paciente

Material y Metodo: 

Estudio Cuasi-Experimental, realizado entre enero del 2011 hasta abril del 2013, en el Hospital de Denia (Alicante) La muestra, una vez aplicados criterios de inclusion y exclusion, fue de 14789 pacientes Las intervenciones realizadas fueron la creacion de un grupo de trabajo, el analisis de los datos retrospectivos, identificacion de las areas de mejora y rediseno del proceso de Alta Hospitalaria basados en la Historia Clinica Electronica La muestra fue clasificada en Preintervencion, Intraintervencion y Postintervencion en funcion del momento temporal del estudio Sobre los profesionales se realizo un Grupo Focal y un estudio de satisfaccion

Resultados: 

La mayoria de las altas del Hospital provienen de ingresos urgentes (65%) y son realizadas por el servicio de Medicina Interna (49%) El tiempo medio de salida de alta ha disminuido de forma significativa en 50 minutos desde Preintervencion a Postintervencion La planificacion del alta, al menos desde el dia anterior, mejora de forma significativa los resultados en 85 minutos de media Todos los procesos relativos al alta fueron normalizados y documentados en un Procedimiento General multidisciplinar La satisfaccion global de los pacientes aumenta en la Postintervencion de forma significativa

Conclusiones: 

La gestion y planificacion del proceso de alta hospitalaria conlleva una mejoria global en la hora de salida del paciente de la organizacion sanitaria La planificacion del alta los dias previos al mismo permite coordinar mejor los procesos y disponer de la salida del paciente de forma anticipada El procedimiento general y las guias de accion rapida estandarizan el trabajo diario de los profesionales implicados en el proceso La satisfaccion de pacientes y familiares aumenta cuando el proceso de alta hospitalaria esta estructurado y planificado La anticipacion de la hora de salida de los pacientes supone un ahorro economico importante
Palabras clave: alta hospitalaria, gestion por procesos, gestion de camas, calidad

https://rua.ua.es/dspace/bitstream/10045/36417/1/tesis_maria_martinez_ramos.pdf

Evaluación y mejora del proceso de alta hospitalaria

https://revistafarmaciahospitalaria.sefh.es/gdcr/index.php/fh/article/download/783/783

M.T. Aznar Saliente

Papers

CONSULTENOS: programa de información al alta hospitalaria. Desarrollo y resultados del primer año de funcionamiento en 5 hospitales

CONSULTENOS: hospital discharge information programmes. Development and results from the first year of operation in 5 hospitals