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Titel: Evaluation of the effects of pharmacist involvement in hospital discharge on quality and completeness of discharge documentation in the IMPACT-care trial.

Authors: Pettersson H, Östman V, Franzon K, Gillespie U.

Institute: Uppsala University, Uppsala, Sweden.

Background: The information given to patients and next care-givers about medication changes at discharge has previously been incomplete. The IMPACT-care trial involves a 4-component intervention designed to improve discharge communication for older (≥65 years) hospitalized patients. CMDD-M is a tool developed to score discharge documentation between 0-9 points.

Aim: To evaluate if the intervention in the IMPACT-care trial had a positive effect on the quality and completeness of discharge documentation, compared to standard of care.

Method: Pre-post intervention study. The study was performed at 2 surgical wards and 1 geriatric ward at Uppsala University Hospital, Sweden. The main outcome measure was CMDD-score. The discharge documentation was blindly scored by two researchers and then discussed to reach consensus. The statistics included significance testing, correlation testing and inter-rater reliability calculation.

Results: 231 patients were included in the study, 117 in the intervention group and 114 in the control group. The intervention group had statistically significantly higher total CMDD-score (4.2 vs. 2.5 points, p<0.001) and higher scores for the discharge letter (2.5 vs. 0.9, p<0.001), than the control group. There were also significantly more patients in the control group who did not receive a discharge letter (45% in the control group vs. 22% in the intervention group, p<0.001). However, very few patients received a perfect score (6% in the intervention group vs. 1% in the control group). The CMDD-score was significantly higher for patients in the intervention group treated at the geriatric ward compared to the surgical wards (5.8 vs. 3.4, p<0.001).

Conclusions: The study shows that the intervention in the IMPACT-care trial had a positive effect on the CMDD-score, especially for the discharge letter. Since the discharge letter is intended for the patient, it gives them necessary information to be able to use their medications correctly. However, there are still improvements to be made and the information to the next care-giver could be improved.