Nursing Home Outreach Clinics show an improvement in patient safety and reduction in hospital admissions in residents with chronic conditions

Abstract

Background: In an environment of an ageing population, with patients exhibiting multiple co-morbidities and taking multiple drugs, as well as attending emergency departments with preventable admissions, the project team aimed to implement and evaluate nursing home outreach clinics. Objectives: To demonstrate the benefit of holding consultant pharmacist-led medication review clinics in nursing homes; improve medication appropriateness and assess if a reduction in the number of hospital admissions was achievable. Methods: Patients were reviewed in outreach clinics in the nursing homes. Data on patient age, number of drugs taken and clinical interventions made was collected for all patients seen. Monthly emergency department attendances were tracked and hospital admissions monitored. More detailed data was collected for 100 patients on type and significance of clinical interventions made, medication appropriateness, using the medication appropriateness index (MAI) and drug costs. Results: Over a 12-month period, in 16 homes, 727 patients were reviewed and an average of 2.9 clinical interventions made per patient. Over the project duration, the average number of hospital admissions from these homes dropped from approximately 3.5 to 1.5 per month. Total estimated drug cost savings for the project over a 2-year time period were estimated at £213k. Individual and total MAI scores for 100 patients, evaluated in more detail, showed a highly significant improvement after clinic review (Wilcoxon Signed Rank test, p<0.001), indicative of more appropriate prescribing. Discussion: Nursing home outreach clinics have resulted in cost-effective and safer patient care via significant clinical interventions and increased appropriateness of drugs prescribed for vulnerable older patients with complex needs.