Table 2 Results from Working Group meetings and semi-structured interviews with community (n = 13) and hospital pharmacists (n = 7)
Community Pharmacists | Hospital Pharmacists | |||
|---|---|---|---|---|
Pros | Cons | Pros | Cons | |
Components of PROMPT intervention | ||||
Faxed discharge prescription | - Legible and logically formatted, easy to read - Distinguishes continued, adjusted, discontinued, and newly started medications in hospital - Included the indication for each medication | - Discharge prescriptions sometimes do not include a prescription for all medications that the patient is taking - Occasionally, necessary information (e.g. prescriber license numbers, insurance information) missing from discharge prescriptions - Medications that patients were only intended to be administered in hospital were occasionally included in discharge prescriptions | - *(WG) The lead role that hospital pharmacists have in generating or reviewing discharge prescriptions allows them to tailor those prescriptions so that they are easier for community pharmacists to understand and process | - (WG) Preparing discharge prescriptions and getting them approved and signed by physicians before they can be faxed is a time-intensive part of the PROMPT intervention for hospital pharmacists |
Faxed discharge summary | - Useful for clarifying issues that were identified in the discharge prescription, which would otherwise necessitate contacting the prescriber - Included lab values and information about follow-up appointments - If receiving discharge summaries was standard practice, community pharmacists would be more’ familiar and adept at extracting useful information from them - Despite receiving more patient information, community pharmacists did not experience challenges in managing, storing, or subsequently accessing this information | - Contained an overwhelming amount of information, much of which was not relevant to the dispensing-focused role of community pharmacy - Did not contain certain information that is relevant to the dispensing-focused role of community pharmacy - Poor presentation and formatting; relevant information difficult to extract from prose - Time-consuming to read in full | - By providing community pharmacists with more patient and hospital information, hospital pharmacists were more confident that interventions made during a patient’s admission would be maintained in the community | - ^(I + WG) Faxing discharge summaries to community pharmacies is a significant departure from hospital pharmacists’ existing workflows - (I + WG) Discharge summaries were often not yet complete at the time that hospital pharmacists were faxing discharge prescriptions to community pharmacies - Extraneous information included in the discharge summary may obfuscate the more relevant information communicated in the discharge prescription and follow-up telephone call - Concerns about maintaining patient privacy given the volume of personal health information transmitted in the discharge summary |
Follow-up telephone call | - Opportunity to discuss the patient’s hospitalization and discharge plan with an informed, reliable source within the hospital - Immediate resolution of prescription issues - Effective way to highlight vital information about the hospitalization and any action items required of the community pharmacy - Allowed community pharmacy to receive patient information that was not included in the faxed documents (e.g. language barriers, living situation) - The standardized telephone call was useful for establishing an open line of communication between the hospital and community pharmacy | - A routine follow-up call may not add value to the intervention, given the community pharmacy has access to the discharge summary and the hospital pharmacist’s contact information | - Enabled hospital pharmacists to convey information that was not included in the faxed documents - Allowed the hospital pharmacist to confirm that the community pharmacy had received the faxed documents - (WG) Follow-up telephone calls were usually short, and subsequent follow-up calls were rarely required | - Routine follow-up calls may not be an efficient use of hospital pharmacists’ time, given that the community pharmacist has the ability to contact them if issues are to arise - (WG) The community pharmacist or pharmacy staff member who received the follow-up call was sometimes not the same as the pharmacist or staff member who received or processed the discharge package |
Hospital pharmacist contact info | - Immediate, streamlined resolution of prescription issues - By avoiding challenges and delays in communicating with hospital prescribers, community pharmacy workflow remains unimpeded | - Only useful during hospital pharmacist’s working hours - Contact information was sometimes illegible or incorrect - Would prefer a direct telephone line rather than a pager number | - (WG) Hospital pharmacists are more comfortable giving their contact information to community pharmacists caring for complex patients than to the patients themselves | - Concerns about potentially receiving excessive telephone calls from community pharmacy - Providing their contact information to community pharmacies is not an existing component of hospital pharmacists’ workflows |
Mode of PROMPT delivery | ||||
Faxing | - Not discussed | - Faxing degraded the resolution and clarity of important medical documents | - Not discussed | - (I + WG) Hospital pharmacists perceived faxing to be unreliable and time-inefficient. - Faxing personal health information to an unknown location within a community pharmacy could violate patient privacy |
Timing of PROMPT delivery | ||||
Faxed discharge prescription | - Receiving a faxed discharge prescription ahead of a complex patient’s arrival allowed the pharmacy to prioritize their workflow and to make necessary arrangements for the patient’s care | - Not discussed | - Expedited delivery of discharge prescription to community pharmacy helps ensure hospital pharmacist’s interventions are quickly implemented in the community | - By faxing the patient’s discharge prescription to their community pharmacy ahead of time, hospital pharmacists could eliminate the patient’s choice of pharmacy and flexibility if their plans were to change suddenly |
Follow-up telephone call | - Not discussed | - Not enough time to review faxed documents before receiving follow-up call from hospital pharmacist | - Calling shortly after faxing was a strategy used to make the community pharmacy aware that they had received discharge documents and to encourage them to begin processing the prescription | - Community pharmacists sometimes had not reviewed faxed documents despite hospital pharmacists waiting a considerable amount of time before calling |
Who delivers PROMPT | ||||
Faxed discharge summary | - Not discussed | - Not discussed | - It may be feasible for hospital pharmacists to generate a community pharmacy-specific note to be faxed in lieu of the discharge summary, were it not yet available | - Hospital pharmacists are unable to facilitate or influence completion of the discharge summary - Ward clerks or other administrative support could be better positioned than hospital pharmacists to fax documents to community pharmacies |
Who receives PROMPT | ||||
Eligibility criteria | - Community pharmacists commonly identified polypharmacy as a characteristic of patients who would benefit from the PROMPT intervention, which was a component of the study’s inclusion criteria (≥ 5 medications upon discharge) | - The study’s enrollment criteria did not explicitly consider many other patient characteristics (e.g. psychiatric illness, physical impairment, those who require compliance packaging) that community pharmacists believed would help identify the most appropriate patients for the PROMPT intervention - Community pharmacists identified a broad, heterogeneous inventory of patient groups that they felt would most benefit from PROMPT | - Hospital pharmacists agreed that polypharmacy was a useful criterion for identifying patients who benefit the most from the PROMPT intervention - A large proportion of the patients encountered in the hospital pharmacists’ practices, including most they believed would benefit from the intervention, satisfied the study’s eligibility criteria | - Hospital pharmacists identified certain patient characteristics (e.g. advanced age, many changes made to a patient’s medication regimen while in hospital) that they felt made a patient ‘complex’, but that were not included in the study’s enrollment criteria - (I + WG) Some patients who did not satisfy the length of hospital stay criterion (≥ 72 h) may still have benefitted from the intervention - The length of stay criterion was the most difficult criterion for hospital pharmacists to confirm was satisfied - (WG) There were intervals during the data collection period of the study when only few patients eligible for PROMPT were admitted under general internal medicine - (WG) There were instances where even if a patient satisfied the study’s eligibility criteria they were not enrolled because there were no changes made to the patient’s medications in hospital and, therefore, no prescription was generated to send to the patient’s community pharmacy |