An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital.

AIMS: To investigate how seamless pharmaceutical care could be delivered. METHODS: Elderly patients discharged from hospital, to their own home, were randomized into control and study groups. Control and study group patients received the normal discharge information. The study group were also counselled about their medicines and informed about their pharmaceutical care plan. Copies of the plan were given to the study patients. All patients received a domiciliary visit between 7 and 10 days after discharge. Their current medication was compared with that on discharge and contact was made with the General Practitioner as appropriate. RESULTS: Twenty-eight study and 25 control patients with a mean (s.d.) age of 77.5 (7.3) and 77.6 (6.1) years completed the study. A pharmaceutical domiciliary visit was necessary for 21 (75%) and 24 (96%) of the study and control patients respectively. Compliance was better (P < 0.01) in the study group. Unintentional changes to the medication of 31 (14 study and 17 control) patients were found during the visit and after contact with the prescriber all but one prescription was restored to that on discharge. CONCLUSIONS: At present it is difficult to ensure seamless pharmaceutical care. A pharmaceutical domiciliary visit may be useful to ensure seamless therapeutic care and thus avoid unnecessary healthcare events and costs after a patient is discharged home.

The effectiveness of drug level monitoring and pharmacokinetics in individualizing theophylline therapy.

A pharmacokinetic method for individualizing theophylline dosage is described. The method was shown to be reliable and accurate, and maintained significantly more patients within the optimum therapeutic range when compared with conventional regimens. The study also showed that when conventional dosage regimens are used, a large proportion of patients exhibit theophylline levels well below the optimum therapeutic range. Population pharmacokinetic data for theophylline and the effect of congestive heart failure on its clearance are also presented.