Abstract
BackgroundOne in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization.MethodsData included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk based on their medical history, were systematically allocated to receive either a medication review (n = 6403) or the standard of care (n = 4380). Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization.ResultsED-based pharmacist-led medication review did not result in a significant level or trend change in the primary outcome of total outpatient health services utilization. There were also no differences in the secondary outcomes of primary care physician visits or ED visits relative to the standard of care in the 12 months following the intervention. Our findings were consistent when stratified by age, hospital site, and whether patients were discharged on their index visit.ConclusionThis was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.
Highlights
One in nine emergency department (ED) visits are caused by an adverse drug event (ADE), the unintended and harmful effects of medication use [1, 2]
During the quality improvement project, the EDs of one tertiary care referral centre (Vancouver General, Vancouver General Hospital (VGH)), and two urban community hospitals (Lions Gate, Lions Gate Hospital (LGH); and Richmond General, Richmond Hospital (RH)) implemented an evidence-based screening tool, which categorized patients into high and low-risk for adverse drug events based on their medication use, preexisting medical problems, and age [15, 16]
When comparing baseline characteristics between groups, the intervention group contained a higher proportion of individuals enrolled at VGH (74.7%), which is the highest acuity hospital among the three participating sites, relative to control (60.5%; p < 0.001, Table 1)
Summary
One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. The effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization. One in nine emergency department (ED) visits are caused by an adverse drug event (ADE), the unintended and harmful effects of medication use [1, 2]. Finding effective interventions to improve early detection and treatment, and effective communication of inappropriate medication therapy and ADEs, has the potential to reduce unnecessary downstream health services utilization and avoid preventable patient harm
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