Pharmacist-led medication reconciliation service for patients after discharge from tertiary hospitals to primary care in Singapore: a qualitative study.

BACKGROUND: Medication discrepancies commonly occur when patients are transferred between care settings. Despite the presence of medication reconciliation services (MRS), medication discrepancies are still prevalent, which has clinical costs and implications. This study aimed to explore the perspectives of various stakeholders on how the MRS can be optimized in Singapore. METHODS: This is a descriptive qualitative study. Semi-structured interviews with 30 participants from the National Healthcare Group, including family physicians (N = 10), pharmacists (N = 10), patients recently discharged from restructured hospitals (N = 7) and their caregivers (N = 3) were conducted. All transcribed interviews were coded independently by three coders and inductive thematic analysis approach was used. RESULTS: Five core themes were identified. (1) The MRS enhanced healthcare services in various aspects including efficiency and health literacy; (2) There were several challenges in delivering the MRS covering processes, technology and training; (3) Issues with suitable patient selection and follow-up; (4) Barriers to scaling up of MRS that involve various stakeholders, cross-sector integration and environmental restrictions; and finally (5) Role definition of the pharmacist to all the stakeholders. CONCLUSION: This study identified the role of MRS in enhancing healthcare services and explored the challenges encountered in the provision of MRS from family physicians, pharmacists, patients and their caregivers. These findings supported the need for a shift of MRS towards a more comprehensive medication review model. Future improvement work to the MRS can be conducted based on the findings.

Deprescribing in Primary Care in Singapore: Barriers and Facilitators.

OBJECTIVES: To describe the prevalence of potentially inappropriate medications (PIMs) in older patients (65 years of age and older) in three selected polyclinics (PCs) and gather the perceptions of the health care providers in these PCs on the barriers and facilitators of deprescribing in their practice. To analyze the patients' age, number of active chronic diseases, and number of medicines, and investigate if they could influence the presence of PIMs. DESIGN: The study has two separate parts: The first part is a retrospective cross-sectional data collection of prescriptions; the second part is a prospective cross-sectional analysis of questionnaires by health care providers. SETTING: The study is in an institutional primary care setting. PATIENTS, PARTICIPANTS: Prescriptions were from 210 randomly selected patients 65 years of age or older with at least five long-term medications, who had attended the PCs over a selected 10-day period. Health care providers from the PCs were surveyed via an anonymous questionnaire. RESULTS: The prevalence of PIMs is 44% of the prescriptions. The most prevalent PIM is "long-term proton pump inhibitor (PPI) without documented indication" at 45.7%. The number of active chronic diseases and total number of medications are associated with prevalence of PIMs. Facilitators and barriers of deprescribing highlighted are motivation and goals of the health care providers, knowledge, lack of time for deprescribing, and communication between specialists and primary care providers. CONCLUSION: PPI is a feasible drug class to start deprescribing in primary care. Knowing the barriers and facilitators would set the impetus for future work to make deprescribing more widespread and acceptable for primary care in Singapore.