Components of intervention and implementation | Content | Participants | |
---|---|---|---|
Intervention | I. Transfer of medical patient data | Information concerning diagnosis, patient’s medication, quality of life, mobility, risk of failing, allergies | GP |
II. Assessment at patients site | Brown bag review and collection of information concerning side effects, adherence, social support and else | Home-care specialist, patient | |
III. Anonymised data transfer to pharmacist | Assessment data | Home-care specialist | |
IV. Medication review and SOAP note | Assessment of pharmacotherapy, generation of a new medication plan, suggestions for monitoring and patient counseling | 2 Pharmacists per patient (one pharmacist generates a first draft of the SOAP note, second one reviews suggested plan) | |
V. Transfer of the SOAP note to home-care specialist | SOAP note and advices addressing home-care specialist tasks | Pharmacist | |
VI. Information of GP | SOAP note with new medication plan, home-care specialist’s note for the GP (concerning for example home-care devices) | Home-care specialist | |
Training concept for implementation | I. Kick-off meetings | Information concerning organizational aspects, process’s time frame, controlling tools, assessment instruments | Home-care specialists, pharmacists, GPs and moderators |
II. profession-specific trainings | Training in medication therapy management, medication review and SOAP-writing | Home-care specialists, pharmacists, and moderators | |
Training in case management | |||
III. training in patient assessment | Assessment instruments, case studies | GPs and moderators | |
IV. Process controlling | Ongoing feedbacks on process performance (e.g. accepted interventions, time frame) | All participants |