Skip to main content
SpringerLink
Log in

Intermediate Care: The Role of Medicines Management

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Healthcare systems worldwide are facing an unprecedented demographic change as globally, the number of older people will triple to 2 billion by the year 2050. The resulting pressures on acute services have been instrumental in the development of intermediate care (IC) as a new healthcare model, which has its origins in the National Health Service in the UK. IC is an umbrella term for patient services that do not require the resources of a general hospital but are beyond the scope of a traditional primary care team. IC aims to promote timely discharge from hospital, prevent unnecessary hospital admissions and reduce the need for long-term residential care by optimizing functional independence. Various healthcare providers around the world have adopted similar models of care to manage changing healthcare needs. Polypharmacy, along with age-related changes, places older people at an increased risk of adverse drug events, including inappropriate prescribing, which has been shown to be prevalent in this population in other healthcare settings. Medicines management (the practice of maximizing health through optimal use of medicines) of older people has been discussed in the literature in a variety of settings; however, its place within IC is largely unknown. Despite IC being a multidisciplinary healthcare model, there is a lack of evidence to suggest that enhanced pharmaceutical involvement is core to the service provided within IC. This review article highlights the gap in the literature surrounding medicines management within IC and identifies potential solutions aimed at improving patient outcomes in this setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. United Nations Department of Economic and Social Affairs Population Division. World population ageing: 1950–2050. Magnitude and speed of population ageing. http://www.un.org/esa/population/publications/worldageing19502050/pdf/80chapterii.pdf. Accessed 14 March 2013.

  2. Riley J. Rising life expectancy: a global history. London: Cambridge University Press; 2001.

    Google Scholar 

  3. Audit Commission. A spoonful of sugar. Medicines management in NHS hospitals. London: Audit Commission; 2001.

    Google Scholar 

  4. Audit Commission. The coming of age: improving care services for older people. London: Audit Commission; 1997.

    Google Scholar 

  5. Australian Government Department of Health and Ageing. Transition Care Program guidelines. Australian Government Department of Health and Ageing; 2011.

  6. Garasen H, Windspoll R, Johnsen R. Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial. BMC Public Health. 2007;2:68.

    Article  Google Scholar 

  7. Espaulellal J, Arnau A, Cubi D, Amblas J, Yanez A. Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care. Age Ageing. 2007;36:407–13.

    Article  Google Scholar 

  8. Lee W, Cheng Y, Liu C, Peng L, Liu L, Chen L. Dose-dependent effect of rehabilitation in functional recovery of older patients in the post-acute care unit. Arch Gerontol Geriatr. 2012;54:290–3.

    Article  Google Scholar 

  9. Department of Health. The NHS Plan: a plan for investment, a plan for reform; 2000.

  10. Melis R, Parker S, van Eijken M. What is intermediate care? An international consensus on what constitutes intermediate care is needed. Br Med J. 2004;329:360–1.

    Article  Google Scholar 

  11. Pencheon D. Intermediate care—appealing and logical, but still in need of evaluation. Br Med J. 2002;324:1347–8.

    Article  Google Scholar 

  12. Young J. The development of intermediate care services in England. Arch Gerontol Geriatr. 2009;49:21–5.

    Article  Google Scholar 

  13. Whyte J, Hart T. It’s more than a black box; it’s a Russian doll—defining rehabilitation treatments. Am J Phys Med Rehabil. 2003;82:639–52.

    PubMed  Google Scholar 

  14. Roe B, Daly S, Shenton G, Lochhead Y. Development and evaluation of intermediate care. J Clin Nurs. 2003;12:341–50.

    Article  PubMed  Google Scholar 

  15. Mariz J, Santos NC, Afonso H, Rodrigues P, Faria A, Sousa N, et al. Risk and clinical-outcome indicators of delirium in an emergency department intermediate care unit (EDIMCU): an observational prospective study. BMC Emerg Med. 2013;13:2.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Pratt J. Long-term care: managing across the continuum. 3rd ed. Sudbury: Jones & Bartlett; 2009.

    Google Scholar 

  17. Shepperd S, Doll H, Angus RM, Clarke MJ, Iliffe S, Kalra L, et al. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2008. doi:10.1002/14651858.CD007491.

  18. Black C, Black D, Alberti G. Intermediate care: statement from the Royal College of Physicians of London. London: Royal College of Physicians; 2000.

    Google Scholar 

  19. Scottish Government. Maximising recovery, promoting independence: an intermediate care framework for Scotland. Scottish Executive, Joint Improvement Team: Scotland; 2012.

    Google Scholar 

  20. Department of Health. National service framework for older people. Department of Health; 2001.

  21. Roe B, Beech R. Intermediate and continuing care: policy and practice. Oxford: Blackwell; 2005.

    Book  Google Scholar 

  22. Steiner A. Intermediate care: a conceptual framework and review of the literature. London: King’s Fund; 1997.

    Google Scholar 

  23. Department of Health. National service framework for older people: supporting implementation—intermediate care: moving forward. London: Department of Health; 2002.

    Google Scholar 

  24. Coleman E. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51:549–55.

    Article  PubMed  Google Scholar 

  25. Linehan K. Medicare’s post-acute care payment: a review of the issues and policy proposals. Issue Brief George Wash Univ Natl Health Policy Forum. 2012;847:1–23.

    PubMed  Google Scholar 

  26. Ministry of Health. Health of older people strategy. Wellington: Ministry of Health; 2002.

    Google Scholar 

  27. Martin G, Peet S, Hewitt G, Parker H. Diversity in intermediate care. Health Soc Care Comm. 2004;12:150–4.

    Article  Google Scholar 

  28. Department of Health. Intermediate care—halfway home. Updated guidance for the NHS and local authorities. Leeds: Department of Health; 2009.

    Google Scholar 

  29. Nancarrow S, Moran A, Freeman J, Enderby P, Dixon S, Parker S, et al. Looking inside the black box of community rehabilitation and intermediate care teams in the United Kingdom: an audit of service and staffing. Qual Prim Care. 2009;17:323–33.

    PubMed  Google Scholar 

  30. Steiner A. Intermediate care—a good thing? Age Ageing. 2001;30:33–9.

    Article  PubMed  Google Scholar 

  31. NHS Benchmarking Network. National audit of intermediate care report. London: NHS Benchmarking; 2012.

    Google Scholar 

  32. Seamark D, Moore B, Tucker H, Church J, Seamark C. Community hospitals for the new millennium. Br J Gen Pract. 2001;51:125–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  33. O’Reilly J, Lowson K, Green J, Young JB, Forster A. Post-acute care for older people in community hospitals—a cost-effectiveness analysis within a multi-centre randomised controlled trial. Age Ageing. 2008;37:513–20.

    Article  PubMed  Google Scholar 

  34. Ward D, Drahota A, Gal D, Severs M, Dean TP. Care home versus hospital and own home environments for rehabilitation of older people. Cochrane Database Syst Rev. 2008. doi:10.1002/14651858.CD003164.

  35. Griffiths PD, Edwards MH, Forbes A, Harris RL, Ritchie G. Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev. 2007. doi:10.1002/14651858.CD002214.

  36. Kane RL, Lin WC, Blewett LA. Geographic variation in the use of post-acute care. Health Serv Res. 2002;37:667–82.

    Article  PubMed  Google Scholar 

  37. Weiss J. Medicare skilled nursing facility benefits. Am J Nurs. 2004;104:65–7.

    Article  PubMed  Google Scholar 

  38. Parsons M, Senior HEJ, Kerse N, Chen M, Jacobs S, Vanderhoorn S, et al. The Assessment of Services Promoting Independence and Recovery in Elders Trial (ASPIRE): a pre-planned meta-analysis of three independent randomised controlled trial evaluations of ageing in place initiatives in New Zealand. Age Ageing. 2012;41:722–8.

    Article  PubMed  Google Scholar 

  39. Hanger C, Griffith J, Lynn S, McGeoch G, Abernethy P. Dinner bed and breakfast for older people: early experiences of a short-term service to manage acute hospital demand. N Z Med J. 2005;118:1439.

    Google Scholar 

  40. Dummit LA. Medicare’s bundling pilot: including post-acute care services. Issue Brief Natl Health Policy Forum. 2011;841:1–23.

    PubMed  Google Scholar 

  41. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10:430–9.

    Article  PubMed  Google Scholar 

  42. Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication-related falls in the elderly causative factors and preventive strategies. Drugs Aging. 2012;29:359–76.

    Article  CAS  PubMed  Google Scholar 

  43. Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42:1017–25.

    Article  PubMed  Google Scholar 

  44. Colley CA, Lucas LM. Polypharmacy—the cure becomes the disease. J Gen Int Med. 1993;8:278–83.

    Article  CAS  Google Scholar 

  45. Rochon P, Gurwitz J. Optimising drug treatment for elderly people: the prescribing cascade. Br Med J. 1997;315:1096–9.

    Article  CAS  Google Scholar 

  46. Bates D, Cullen D, Laird N, Petersen L, Small LS, Servi D, et al. Incidence of adverse drug events and potential adverse drug events—implications for prevention. JAMA. 1995;274:29–34.

    Article  CAS  PubMed  Google Scholar 

  47. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. Br Med J. 2004;329:15–9.

    Article  Google Scholar 

  48. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Prescribing in elderly people—appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173–84.

    Article  PubMed  Google Scholar 

  49. Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.

    Article  PubMed  Google Scholar 

  50. Bradley MC, Fahey T, Cahir C, Bennett K, O’Reilly D, Parsons C, et al. Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. Eur J Clin Pharmacol. 2012;68:1425–33.

    Article  PubMed  Google Scholar 

  51. Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68:936–47.

    Article  PubMed  Google Scholar 

  52. Byrne S, Ryan C, O’Mahony D, Weedle P, Kennedy J, Ahern E. Inappropriate prescribing in the elderly: a review of primary care and nursing home prescriptions. Int J Pharm Pract. 2008;Suppl 1:A36–7.

    Google Scholar 

  53. Bakken MS, Ranhoff AH, Engeland A, Ruths S. Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards. Scand J Prim Health Care. 2012;30:169–75.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Stegemann S, Ecker F, Maio M, Kraahs P, Wohlfart R, Breitkreutz J, et al. Geriatric drug therapy: neglecting the inevitable majority. Ageing Res Rev. 2010;9:384–98.

    Article  PubMed  Google Scholar 

  55. Salzman C. Medication compliance in the elderly. J Clin Psychiatry. 1995;56:18–23.

    PubMed  Google Scholar 

  56. Claxton A, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23:1296–310.

    Article  CAS  PubMed  Google Scholar 

  57. Li W, Wallhagen MI, Froelicher ES. Hypertension control, predictors for medication adherence and gender differences in older Chinese immigrants. J Adv Nurs. 2008;61:326–35.

    Article  PubMed  Google Scholar 

  58. Banning M. A review of interventions used to improve adherence to medication in older people. Int J Nurs Stud. 2009;46:1505–15.

    Article  PubMed  Google Scholar 

  59. Wu JYF, Leung WYS, Chang S, Lee B, Zee B, Tong PCY, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. Br Med J. 2006;333:522–5.

    Article  Google Scholar 

  60. Hughes C. Medication non-adherence in the elderly—how big is the problem? Drugs Aging. 2004;21:793–811.

    Article  PubMed  Google Scholar 

  61. Nancarrow S, Dixon S, Kaambwa B, Martin GP, Bryan S. The relationship between staff skill mix, costs and outcomes in intermediate care services. BMC Health Serv Res. 2010;10:221.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Department of Health Social Services and Public Safety. Audit of intermediate care. Final intermediate care report, vol I. Belfast: DHSSPS; 2006.

    Google Scholar 

  63. Sue Burke EN. Pharmacists and the new intermediate care agenda. London: Royal Pharmaceutical Society of Great Britain; 2002.

    Google Scholar 

  64. Amin H, Dave K, Barnett N. Ways clinical pharmacists can add value in intermediate care settings. Clin Pharm. 2011;3:378–9.

    Google Scholar 

  65. Masters S, Halbert J, Crotty M, Cheney F. What are the first quality reports from the Transition Care Program in Australia telling us? Australas Ageing. 2008;27:97–102.

    Article  Google Scholar 

  66. Masters S, Giles L, Halbert J, Crotty M. Development and testing of a questionnaire to measure older people’s experience of the Transition Care Program in Australia. Australas J Ageing. 2010;29:172–8.

    Article  PubMed  Google Scholar 

  67. Hughes CM, Lapane KL. Pharmacy interventions on prescribing in nursing homes: from evidence to practice. Ther Adv Drug Saf. 2011;2:103–12.

    Article  Google Scholar 

  68. Hughes CM, Lapane KL. Administrative initiatives for reducing inappropriate prescribing of psychotropic drugs in nursing homes—how successful have they been? Drugs Aging. 2005;22:339–51.

    Article  PubMed  Google Scholar 

  69. Al-Rashed S, Wright D, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;54:657–64.

    Article  CAS  PubMed  Google Scholar 

  70. Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004;2:257–64.

    Article  PubMed  Google Scholar 

  71. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies—prevalence and contributing factors. Arch Intern Med. 2005;165:1842–7.

    Article  PubMed  Google Scholar 

  72. National Patient Safety Agency and National Institute for Health and Clinical Excellence. Technical safety solutions. 2007. http://www.nice.org.uk/nicemedia/pdf/PSG001Guidance.pdf. Accessed 9 Sep 2013.

  73. Tonna AP, Stewart D, West B, McCaig D. Pharmacist prescribing in the UK—a literature review of current practice and research. J Clin Pharm Ther. 2007;32:545–56.

    Article  CAS  PubMed  Google Scholar 

  74. McCann L, Lloyd F, Parsons C, Gormley G, Haughey S, Crealey G, et al. “They come with multiple morbidities”: a qualitative assessment of pharmacist prescribing. J Interprof Care. 2012;26:127–33.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors have no conflicts of interest that are directly relevant to the content of this review. This work was supported by the Department for Employment and Learning (DEL), Northern Ireland. No other sources of funding were used in the preparation of this review.

Author information

Authors and Affiliations

  1. Clinical and Practice Research Group, School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland

    Anna N. Millar, Carmel M. Hughes & Cristín Ryan

  2. Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland

    A. Peter Passmore

Authors
  1. Anna N. Millar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carmel M. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Peter Passmore
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristín Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cristín Ryan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Millar, A.N., Hughes, C.M., Passmore, A.P. et al. Intermediate Care: The Role of Medicines Management. Drugs Aging 31, 21–31 (2014). https://doi.org/10.1007/s40266-013-0133-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-013-0133-5

Keywords

Search

Navigation