Medication management during transitions from hospital to home: a focus group study with hospital and primary healthcare providers in the Netherlands.

Background Medication management is jeopardized during a patient's transition from hospital to home. Insight is required from both hospital and primary healthcare providers on how care should be organised to achieve continuity of medication management. Objective This study aimed to identify perspectives of hospital and primary healthcare providers on barriers to the continuity of medication management during a patient's transition from hospital to home and facilitators to overcome these. Setting A qualitative descriptive study was conducted within hospital and primary healthcare settings in the Netherlands. Method Two focus groups were performed with two community care registered nurses, two community pharmacists, four general practitioners, two hospital nurses, two hospital pharmacists, four outpatient pharmacists, two pharmacy technicians, and one physician. A semi-structured interview guide was used to identify perspectives of participants on barriers to continuity of medication management and facilitators to overcome these. Data were analysed following thematic content analysis. Main outcome measure Barriers to the continuity of medication management during a patient's transition from hospital to home would be enumerated, along with facilitators to overcome these barriers. Results Three main themes of barriers and facilitators were identified: (1) healthcare provider collaboration, including the transfer of medication information and effective collaboration; (2) patient's medication use, including information about medication, personalised care, and supervision after discharge; and (3) organisation of healthcare, including the connection between information systems and the supply of medication. Conclusion Barriers and facilitators to continuity of medication management during the transition from hospital to home occur at the provider, patient, and healthcare-system levels. Future interventions should focus on all levels through interprofessional healthcare teams, tailoring care to patient needs, and on the use of a uniform, nationwide patient electronic health record.

The cardiac care bridge program: design of a randomized trial of nurse-coordinated transitional care in older hospitalized cardiac patients at high risk of readmission and mortality.

BACKGROUND: After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation. METHODS: In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15-23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden. DISCUSSION: This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care. TRIAL REGISTRATION: NTR6316 . Date of registration: April 6, 2017.

Assessing the relationship between maternal and neonatal factors and low birth weight in Iran; a systematic review and meta-analysis.

Introduction. Low birth weight is an important indicator of the health of babies. A low birth weight is a leading health problem and a major reason for death in newborns. This study targeted to assess the relationship between maternal and infant factors and low birth weight in Iran through a systematic review and meta-analysis. Materials and Methods. This paper was a systematic review and meta-analysis of the relationship between maternal/ infant factors and low birth weight based on the published research papers conducted in Iran. To achieve this goal, two trained researchers independently elicited all the relevant articles by using the appropriate keywords and their combinations in SID, Madlib, Iranmedex, Irandoc, Google Scholar, Pubmed, ISI, Scopus and Magiran databases. The results of the study were combined with SPSS 20 and STATA software. Results. In the initial stage, 25 more relevant articles out of 46 papers were selected. The gestational age with less than 37 weeks and prenatal care had the most (CI: 27- 14. 53, OR: 19.81) and the least (CI: 1.86, OR: 1.5) effect on the low birth weight in newborns, respectively. Conclusion. This study showed that there is a significant relationship between the low birth weight and multiple births, pre-eclampsia, maternal weight gaining during pregnancy, baby's gender, and pregnancy age. Hence, controlling the factors above in mothers during pregnancy by the health authorities could lead to the birth of infants with a healthy weight and consequently the number of infants with low birth weight will decrease.