Duggan, Catherine Anne; (1998) An evidence based approach to developing pharmaceutical service provision across the primary: secondary health care interface. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Communication breakdown has been identified in pharmaceutical service provision as patients move from their homes in the community into hospital and back home again. Discrepancies between supplies of prescribed drugs obtained between the two health care sectors, had previously been identified in patient populations perceived to be 'at risk', such as the elderly, or those with multiple therapies. The purpose of this work was to investigate the incidence of such discrepancies in supplies of prescribed drugs in general medical patients and to systematically develop an appropriate, workable intervention to reduce their occurrence within current practice. The perceptions of these patients and relationships with their behaviours and motivations towards their prescribed drugs were explored. The study takes an evidence based approach to developing pharmaceutical service provision across the primary:secondary health care interface, validated by multidisciplinary perspectives and evaluated through patient-centred outcomes. The extent of the discrepancies with prescribed drugs was measured and described, the perceptions of the patients explored. The results of the Exploratory Phase were used as evidence to develop an intervention that addressed the identified problem, and relevant outcome measures were designed based on these findings. A subsequent controlled cohort study found that, for every fifteen patients discharged from the hospital with information regarding drugs prescribed at discharge to give to their community pharmacists, a discrepancy that would have a direct adverse effect on the patient is prevented. The findings suggest that community pharmacists are professionally empowered by the receipt of such information, they are able to promote the use of their unique drug knowledge base and, through their interaction with the patient, ensure informed medicines management whilst gaining insight into patient behaviours and motivations towards their prescribed drugs.

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