BACKGROUND: Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge.METHODS: A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data.RESULTS: We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79).CONCLUSIONS: A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
Mexican oregano is a non-timber forest product harvested in natural vegetation and represents an important source of income for rural families. Recent reports have highlighted decreases in natural populations caused by increased harvest intensity. Oregano leaf harvesting is a complex problem, involving different components and views, and has a clear spatial dimension. We proposed an analytical framework based on multi-criteria-multi-objective analyses. GIS tools were used as the platform for managing, displaying and analyzing ecological and socioeconomic information from different sources in order to evaluate land suitability of three different management strategies for two competing land objectives: oregano Harvest and oregano Regeneration. The incorporation of environmental evaluation criteria in the analysis allowed the identification of new potential oregano harvesting areas which were neither reported by harvesters, nor registered during harvesting trips. Socio-economic criteria, such as land tenure, highlighted the fact that a substantial proportion of current oregano harvesting areas are located outside ejido limits resulting in potential conflicts for resource access. The proposed Balanced oregano management strategy, in which the same proportion of suitable area (50%) was assigned to both objectives, represents the most favorable management strategy. This option allows harvesters to continue earning an income from oregano leaf harvest; and at the same time helps in the selection of the best areas for oregano regeneration. It also represents a management strategy with a smaller impact on oregano populations and on the harvesters ́ income, as well as lower monitoring costs. The proposed analytical frame-work may contribute to advance the application of systematic approaches for solving decision-making problems in areas where oregano leaves and other NTFP are harvested.
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