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Open Access Highly Accessed Study protocol

The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in a multicultural population of internal medicine patients

Fatma Karapinar-Çarkıt12, Sander D Borgsteede13, Jan Zoer1, Carl Siegert4, Maurits van Tulder5, Antoine CG Egberts26 and Patricia MLA van den Bemt27*

Author Affiliations

1 Department of Hospital Pharmacy, Amsterdam, The Netherlands

2 Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht University, Utrecht, The Netherlands

3 Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands

4 Department of Internal Medicine, Amsterdam, The Netherlands

5 Department of Health Sciences, Faculty of Earth & Life Sciences, Amsterdam, The Netherlands

6 Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands

7 Department of Hospital Pharmacy, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

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BMC Health Services Research 2010, 10:39  doi:10.1186/1472-6963-10-39

Published: 16 February 2010

Abstract

Background

Medication errors occur frequently at points of transition in care. The key problems causing these medication errors are: incomplete and inappropriate medication reconciliation at hospital discharge (partly arising from inadequate medication reconciliation at admission), insufficient patient information (especially within a multicultural patient population) and insufficient communication to the next health care provider. Whether interventions aimed at the combination of these aspects indeed result in less discontinuity and associated harm is uncertain. Therefore the main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in patients discharged from the internal medicine department.

Methods/Design

An experimental study is performed at the internal medicine ward of a general teaching hospital in Amsterdam, which serves a multicultural population. In this study the effects of the COACH program is compared with usual care using a pre-post study design. All patients being admitted with at least one prescribed drug intended for chronic use are included in the study unless they meet one of the following exclusion criteria: no informed consent, no medication intended for chronic use prescribed at discharge, death, transfer to another ward or hospital, discharge within 24 hours or out of office hours, discharge to a nursing home and no possibility to counsel the patient.

The intervention consists of medication reconciliation, patient counselling and communication between the hospital and primary care healthcare providers.

The following outcomes are measured: the primary outcome readmissions within six months after discharge and the secondary outcomes number of interventions, adherence, patient's attitude towards medicines, patient's satisfaction with medication information, costs, quality of life and finally satisfaction of general practitioners and community pharmacists.

Interrupted time series analysis is used for data-analysis of the primary outcome. Descriptive statistics is performed for the secondary outcomes. An economic evaluation is performed according to the intention-to-treat principle.

Discussion

This study will be able to evaluate the clinical and cost impact of a comprehensive program on continuity of care and associated patient safety.

Trial registration

Dutch trial register: NTR1519