Abstract
Background There is a major drive within healthcare to reduce patient readmissions, from patient care and cost perspectives. Pharmacist-led innovations have been demonstrated to enhance patient outcomes. Objective To assess the impact of a post-discharge, pharmacist-led medicines optimisation clinic on readmission parameters. Assessment of the economic, clinical and humanistic outcomes were considered. Setting Respiratory and cardiology wards in a district general hospital in Northern Ireland. Method Randomised, controlled trial. Blinded random sequence generation; a closed envelope-based system, with block randomisation. Adult patients with acute unplanned admission to medical wards subject to inclusion criteria were invited to attend clinic. Analysis was carried out for intention-to-treat and per-protocol perspectives. Main Outcome Measure 30-day readmission rate. Results Readmission rate reduction at 30 days was 9.6% (P = 0.42) and the reduction in multiple readmissions over 180-days was 29.1% (P = 0.003) for the intention-to-treat group (n = 31) compared to the control group (n = 31). Incidence rate ratio for control patients for emergency department visits was 1.65 (95% CI 1.05–2.57, P = 0.029) compared with the intention-to-treat group. For unplanned GP consultations the equivalent incident rate ratio was 2.00 (95% CI 1.18–3.58, P = 0.02). Benefit to cost ratio in the intention-to-treat and per-protocol groups was 20.72 and 21.85 respectively. Patient Health Related Quality of Life was significantly higher at 30-day (P < 0.001), 90-day (P < 0.001) and 180-day (P = 0.036) time points. A positive impact was also demonstrated in relation to patient beliefs about their medicines and medication adherence. Conclusion A pharmacist-led post-discharge medicines optimisation clinic was beneficial from a patient care and cost perspective.
Highlights
One strategic target in health care systems is to reduce the frequency of unplanned re-hospitalisations, which have progressively increased in rate and cost burden worldwide
Since optimising medicines use is a key process in effective disease management, pharmacists have a significant role to play in patient care after discharge from hospital
In a recent systematic review, which included 19 randomised controlled trials [25] it was estimated that in-hospital clinical pharmacist-led services resulted in a significant 30% reduction in emergency department visits post-discharge. That many of these latter components are already provided in the Integrated Medicines Management (IMM) programme [7,8,9] that is delivered as routine practice to patients in the study site hospital by clinical pharmacy staff, i.e. the present results demonstrate additional authenticity to the IMM program
Summary
One strategic target in health care systems is to reduce the frequency of unplanned re-hospitalisations, which have progressively increased in rate and cost burden worldwide. Since optimising medicines use is a key process in effective disease management, pharmacists have a significant role to play in patient care after discharge from hospital. One in eight patients has a medicine related problem [5]. Certain patients are at high risk of having difficulties in managing their medicines when discharged from hospital which can often result in the patient being readmitted [6]. Care is taken to support patients managing their medicines and medical conditions prior to discharge [7,8,9], they often face significant challenges when they return home. There is a major drive within healthcare to reduce patient readmissions, from patient care and cost perspectives. Pharmacist-led innovations have been demonstrated to enhance patient outcomes
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