Personal Satisfaction Clinical Trial
Official title:
Impact of a Pharmaceutical Intervention Program at Readmission and User Satisfaction in a Emergency Department, Randomized Clinical Study
A randomized clinical trial with two parallel groups (control and intervened) in the
Emergency Department (ED) at the Clinical Hospital of the University of Chile will take
place. The sample will be of 996 patients (498 per group).
The control group will receive hospital care and discharge plan usual, while the
intervention group also receive a Program of Pharmaceutical Interventions while in the
service and at discharge, which includes an analysis of the therapy recommended by the
physician, assessing the safer alternatives for the patient population and the special
conditions of their pathology, emphasizing evaluations of effectiveness, safety and
tolerability of medication, drug interactions, potential adverse events, dose adjustments as
needed according to the patient's condition ; verification that the administration is
optimal, including choosing the best route to this and the time when the drugs are infused
into the patient.Interventions aimed at patient occur during the stay and at discharge,
focusing on clarifying administration regimens, reasons for using drugs, prevent
drug-related problems, clarify doubts and educate about pharmacotherapy and make a
reinforcement of adherence.
The selection and patient recruitment will take place during the first hour of admission to
care box, where they were invited to participate and signed informed consent.
In both groups, a doctor and a pharmacist, blind to treatment assignment, will gather
information during the stay, discharge and post-discharge, the latter by telephone 30 days
after discharge from the ED, in this second interview also verify the existence of a
readmission and / or unscheduled medical consultation. In addition, discharge of each
patient satisfaction was measured with respect to the service received by a user
satisfaction survey applied by external and impartial staff. In addition, two independent
trained evaluators (Emergency Medical and Pharmaceutical Chemistry), blinded to treatment
assignment, evaluate the background of each case and by consensus allocated the presence of
problems related to drugs, and classified as preventable or not preventable, according
severity.
X2 test or Fisher exact test was used to test the hypothesis that the Programme of
Pharmaceutical Interventions decreases at least 30% the user dissatisfaction compared with
usual care in the ED.
Process:
For the selection of patients, a research team consisting of a Physician and a
Pharmaceutical Chemist review the inclusion and exclusion criteria within the first hour
after the patient enters the care box. Patients who meet the selection criteria are invited
to participate in the study and sign the informed consent form. To standardize the sampling
and avoid differences by daily or seasonal variation are included in the study of 6 patients
per day.
For each of the included patients, information will be collected that allows the
characterization: sociodemographic, which includes: sex, age, foresight, schooling, marital
status; Morbid antecedents before, during the care and after the high diagnostic illness,
reason of admission and previous hospitalizations; Pharmacotherapeutic which includes
medicines used, dosage, self-medication, adherence (Morisky & Green Scale), performed
before, during the stay in the emergency department and high and post discharge. In
addition, the Triage category and the duration of the stay are recorded.
In both groups, a physician and a pharmacist, blind to the allocation of treatment, collect
the demographic, morbid and pharmacotherapeutic antecedents, by means of a file specially
designed for the study. The post-discharge evaluation is done through the telephone
interview 30 days after the discharge from the US.
All information collected on the follow-up sheets of each study patient will be added to an
Excel® database. A project investigator will be responsible for ensuring the monitoring of
the study, ensuring that Good Clinical Practices are complied with, as well as the quality
and reliability of the information recorded on both the records and the database. Both the
database and each of the study collection records will include only a patient identification
code, in order to maintain their confidentiality. The list that relates the code to the
patient's name will be kept protected with access only to the principal investigator.
In the case of the patients who are part of the intervention group, in addition to the care
received by the control group, I received a pharmaceutical care program aimed at improving
drug use and patient safety. It includes a finished analysis of the therapy indicated by the
physician, evaluating the safer alternatives for the type of patient and the special
conditions of his pathology, emphasizing evaluations of the effectiveness, safety and
tolerability of the medication, drug interactions, possible events Adverse effects, dose
adjustments by sea, patient conditions; Verification of what the sea of optimal management,
including the choice of the best route for the shelf and the time in which the medicines are
infused to the patient.
The intervention is performed at moments one during the stay in the service where they
communicate and educate the patient about all the medications indicated and the
relationship, which have their health status, as well as the benefits and expected results
with their administration. A second moment just after high medicine, where the same review
of medications is done and recommendations are given to the patient on how to administer
them, promoting adherence to treatment. In addition to all the knowledge he has about his
pathology and treatment.
To see that the patient started therapy, the last 7 days after discharge / transfer of the
Emergency Service, a member of the team communicated by telephone with the patient. In case
you have not started looking for the factors that affected your behavior.
At 30 days after discharge / transfer, an independent external evaluator, blinded to
pharmaceutical care, who will not know the group to which the patient belongs, will be
contacted by telephone and evaluated again, in addition to consulting medical prescriptions
Received and medications purchased to evaluate hospital readmissions or unscheduled medical
consultations.
If an error is detected in the control group, it will be communicated to the health team
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