Care pathways production and review checklist: results from an HTA evaluation.

INTRODUCTION: The study aims to assess the implications of using a specific checklist in the production and review of care pathways. Care pathways have been developed to plan and standardize clinical practice, although the way they are designed remains unclear. METHODS: This study was implemented through a Health Technology Assessment model, assuming the hospital perspective. The checklist consists of 7 different domains, subdivided into 14 subdomains and 77 items. RESULTS: After a prioritization phase, our analysis reported a better performance of the checklist in terms of safety [2.00 vs -0.04; p<0.001], effectiveness [1.33 vs 0.00; p<0.001], social and ethical impact [1.15 vs 0.33; p<0.001], and legal perception from healthcare professionals [1.23 vs 0.25; p<0.001]. The Cost-Effectiveness Analysis and Budget Impact Analysis showed an advantage of the checklist (5.75% annual economic saving). CONCLUSIONS: A dedicated checklist may lead to potential benefits in terms of quality of care pathway processes.

Measures of Drug Prescribing at Care Transitions in an Internal Medicine Unit.

Care transitions represent a common source of drug errors and confusions. The purpose of our prospective observational study was to assess the prevalence of medication discrepancies at care transitions, along with potentially inappropriate medications and potential drug-drug interactions, in an internal medicine unit of an Italian hospital. Adverse drug reactions that occurred in the 30-day period after the discharge from the hospital were included. A related-samples McNemar test was performed for evaluating the effects of hospitalization on the above-mentioned measures of drug prescribing. Medication discrepancies were frequent both on admission (93.4% [95%CI 0.8749, 0.9713]) and at discharge (78.7% [95%CI 0.7035, 0.8558]), with a significant difference between transition times (-14.7% [95%CI -21.82%, -7.69%]; P < .001)]. A high potentially inappropriate medication use prevalence was revealed without differences between care transitions. Potential drug-drug interactions were more frequent at admission to the hospital, with a significant difference of 8.2% in the distribution of patients with potential drug-drug interactions between care transitions. None of the adverse drug reactions recorded on follow-up was related to unintentional discrepancies, and the prevalence rate of patients with potentially inappropriate medication-related adverse drug reactions ranged between 4.9% and 6.9%, and the prevalence rate of patients with drug-drug interaction-related adverse drug reactions was 4.1% of patients. This study is important to raise awareness of the potential dangers medication discrepancies, potentially inappropriate medications, and potential drug-drug interactions could have on older adults. Clinicians and clinical pharmacologists must collaborate to improve patient care and minimize drug-related clinical outcomes.