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Hospital pharmacy aspects of discharge management in Baden-Wuerttemberg hospitals – survey results 2017 and future perspectives
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Veröffentlicht: | 23. November 2018 |
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Background: Since October 2017, a special framework agreement (“Rahmenvertrag Entlassmanagement”) makes German patients eligible for being involved into a special discharge procedure (Entlassmanagement, EMG). In this context, hospital staff is looking closely at the patient, its medical and medication history together with social aspects in order to improve the procedure of discharge. From pharmaceutical point of view, there is a focus on the improvement of patient medication and supply with important medicines during the time between hospital discharge and general practitioner visit. The generation and professional editing of special documents like the “Medication Plan” and special “Discharge Prescriptions” are some of the relevant tools. Nevertheless, the implementation of the new standards represents a big challenge for the hospitals.
Materials and methods: In order to measure the degree of EMG-implementation and acceptance of the framework agreement, we performed a short anonymized survey in Baden-Wuerttemberg hospital pharmacies. This survey consisted of 22 questions on the subjective importance of EMG for the patient and other players in health system, the estimation of the quality of discharge management (along with the subjective appraisal of the current quality of the relevant documents) and a selection of clinical pharmacy services. Last but not least, opinion could be given about problems during implementation, need for special education and training and required personal support. Data was analyzed in an anonymous manner.
Results: We assessed the results as representative since 49 percent of the questionnaires have been completed. Nevertheless, the answers drew a heterogenous picture regarding the assessment oft he importance of EMG. Regarding the clinical pharmacy services, some hospital pharmacies are very active (independently of the hospital size). Assessment of the quality of discharge prescription documents and medication plans was very heterogeneous. Hospitals can further improve but need human resources support (est. as 0.6 fulltime equivalents per 500 beds).
Conclusion: Our findings show that the current state of implementation is (at least measured as a personal estimation) is capable of further development - hospitals should escalate their efforts to guarantee best standards of discharge management for their patients. We are going to repeat the survey in order to measure putative progress in quality but, more important, we currently are finalizing a study protocoll with the purpose of the development of improved concepts and interventions within discharge management (EMG). In this regard, we are going to start with a short-term pilot study (supported by the Baden-Wuerttemberg Chamber of Pharmacists) in order to obtain proof of our concept. In a subsequent project phase, we plan to broaden this discharge management study in order to effectively reach a more significant proportion of interested hospitals - supported by intensive educational activities.