دورية أكاديمية
An electronic pillbox intervention designed to improve medication safety during care transitions: challenges and lessons learned regarding implementation and evaluation.
| العنوان: | An electronic pillbox intervention designed to improve medication safety during care transitions: challenges and lessons learned regarding implementation and evaluation. |
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| المؤلفون: | Shahani A; Pharmacy Department, Brigham and Women's Hospital, Boston, MA, USA., Nieva HR; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.; Department of Medicine, Harvard Medical School, Boston, MA, USA., Czado K; Pharmacy Department, Brigham and Women's Hospital, Boston, MA, USA., Shannon E; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA.; Department of Medicine, Harvard Medical School, Boston, MA, USA., Gaetani R; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA., Gresham M; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA., Garcia JC; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA., Ganesan H; Fellow (Formerly TowerView Health), Philadelphia, PA, USA., Cerciello E; Fellow (Formerly TowerView Health), Philadelphia, PA, USA., Dave J; Fellow (Formerly TowerView Health), Philadelphia, PA, USA., Jain R; Fellow (Formerly TowerView Health), Philadelphia, PA, USA., Schnipper JL; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3, Boston, MA, 02120, USA. jschnipper@bwh.harvard.edu.; Department of Medicine, Harvard Medical School, Boston, MA, USA. jschnipper@bwh.harvard.edu. |
| المصدر: | BMC health services research [BMC Health Serv Res] 2022 Oct 30; Vol. 22 (1), pp. 1304. Date of Electronic Publication: 2022 Oct 30. |
| نوع المنشور: | Review; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BioMed Central, [2001- |
| مواضيع طبية MeSH: | Patient Transfer* , Pharmacists*, Humans ; Patient Discharge ; Hospitals, Teaching ; Electronics ; Randomized Controlled Trials as Topic |
| مستخلص: | Background: Adverse drug events are common during transitions of care. As part of the Smart Pillbox study, a cluster-randomized controlled trial of an electronic pillbox designed to reduce medication discrepancies and improve medication adherence after hospital discharge, we explored barriers to successful implementation and evaluation of this intervention. Methods: Eligible patients were those admitted to a medicine service of a large teaching hospital with a plan to be discharged home on five or more chronic medications. The intervention consisted of an electronic pillbox with pre-filled weekly blister pack medication trays given to patients prior to discharge. Pillbox features included alarms to take medications, detection of pill removal from each well, alerts to patients or caregivers by phone, email, or text if medications were not taken, and adherence reports accessible by providers. Greater than 20% missed doses for three days in a row triggered outreach from a pharmacist. To identify barriers to implementation and evaluation of the intervention, we reviewed patient exit surveys, including quantitative data on satisfaction and free-text responses regarding their experiences; technical issue logs; and team meeting minutes. Themes were derived by consensus among the study authors and organized using the Consolidated Framework for Implementation Research. Results: Barriers to implementation included intervention characteristics such as perceived portability issues with the pillbox and time required by pharmacists to enter medication information into the software; external policies such as lack of insurance coverage for early refills and regulatory prohibitions on repackaging medications; implementation climate issues such as the incompatibility between the rushed nature of hospital discharge with the time required to deploy the intervention; and patient issues such as denial of previous problems with medication adherence. We founds several obstacles to conducting the study, including patients declining study enrollment and limited attempts by the hospital to streamline logistics by building the intervention into usual care. Several solutions to address many of these challenges were implemented or planned. Despite these challenges, many patients with the pillbox were pleased with the service and believed the intervention worked well for them. Conclusions: In this evaluation, several barriers to implementing and conducting a study of the effectiveness of the intervention were identified. Our findings provide lessons learned for others wishing to implement and evaluate HIT-related interventions designed to improve medication safety during care transitions. Trial Registration: Clinicaltrials.gov NCT03475030. (© 2022. The Author(s).) |
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| فهرسة مساهمة: | Keywords: Care transitions; Health information technology; Implementation science; Medication safety |
| سلسلة جزيئية: | ClinicalTrials.gov NCT03475030 |
| تواريخ الأحداث: | Date Created: 20221030 Date Completed: 20221101 Latest Revision: 20221102 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC9618185 |
| DOI: | 10.1186/s12913-022-08702-y |
| PMID: | 36309744 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1472-6963 |
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| DOI: | 10.1186/s12913-022-08702-y |