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IMPLEMENTATION OF A NEW MODEL OF MEDICATION DELIVERY AND CLINICAL PHARMACY FOLLOW-UP IN A TERTIARY HOSPITAL

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European Statement

Clinical Pharmacy Services

Why was it done?

Due to the COVID-19 lockdown, many patients could not attend to hospital pharmacy for medication supply. To ensure treatment effectiveness, tolerance and therapeutic adherence, we developed this new model of medication dispensing as well as additional routes of patient follow-up, such as the use of mobile Health (mHealth).

What was done?

In 2024/03 we started to approach hospital medication (mainly onco-haematology oral treatments, subcutaneous monoclonal antibodies and clotting factors) to the patient’s home. We developed an alternative model of medication supply through the collaboration with community pharmacies (CPs) and a logistics partner.

How was it done?

The collaboration with CPs was coordinated by the Barcelona College of Pharmacists, who developed a new digital platform to manage and track delivery orders. A pharmaceutical wholesaler delivered these medications to CPs in 48–72 hours. In case of requiring a faster dispensation, we used a logistics operator which guaranteed a delivery time to the patient’s home of 24 hours.
Considering that our hospital pharmacy attends more than 8,000 patients, we prioritised this service to those with a complex socio-functional situation or who lived far from the hospital.
Pharmacy technicians were the key managers in this process. Through a telephone interview, they detected possible medication related problems (adverse effects, administration errors, inadequate dose/route of administration/duration of therapy and lack of treatment adherence). They also checked for in-person medical appointments that could justify dispensing direct to the patient. If any incident was detected, the technician referred the case to the pharmacist for further assessment and resolution.
Additionally, for some health conditions (heart transplant, colorectal and breast cancer, haematopoietic stem cell transplant, chronic migraine or HIV infection), we developed a mHealth programme in which patients were empowered by using a smartphone and tablet app to promote self-care management and contact with their healthcare professionals.

What has been achieved?

In 2020, 4,793 shipments were made to 1,814 patients. This meant 12.4% of the total hospital pharmacy dispensations (N=38,527). Of these shipments, 61.0% went to CPs and 39.0% to patients at home. In 2021, there were 4,171 shipments to 1,248 patients, 90.0% of which were sent to CF, which implies a decrease of the shipments of 12.9% compared to the previous year.
In our setting, mean time of virtual dispensing was 10 minutes versus 3 minutes of in-person dispensing. This additional time was due to the preparation of drug shipments and tracked delivery orders. The assessment of this model was positive for both patients and pharmacy staff. However, it was not exempt from some incidents, such as delivery delays or errors in package identification.
As for telepharmacy follow-up, 257 patients are using mHealth applications. In 2021, they performed 4,387 consultations with the pharmaceutical team.

What next?

The COVID-19 pandemic forced us to rethink the care model for outpatient care in hospital pharmacy services. Our assessment is positive and we believe that this model should continue in the future for a selected group of patients.

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