Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka.

Andrew Hamilton Dawson,Fahim Mohamed,Dhineli Perera,Ian Coombes,Chandrani Nirmala Wijekoon,Lelwala Guruge Thushani Shanika,Hithanadura Asita De Silva,Judith Coombes,Shaluka Jayamanne

doi:10.2471/blt.17.198366

Abstract

ObjectiveTo assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions.MethodBetween March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions.ResultsData from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001).ConclusionA ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.

Highlights

Noncommunicable diseases, such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, are a major global health burden and are an increasing problem in lowand middle income countries.[1,2] An important component of care for noncommunicable diseases is the quality use of medicines – that is, selecting management options wisely, choosing suitable medicines if a medicine is considered necessary and using medicines safely and effectively
Failure of following this component may lead to drug-related problems, which are defined as “an event or circumstance involving drug therapy that or potentially interferes with desired health outcomes.”[3]. Such problems cause a large number of hospital admissions, many of which are avoidable.[4]
This study evaluates the impact of a clinical pharmacy service in a Sri Lankan hospital

Summary

Introduction

Noncommunicable diseases, such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, are a major global health burden and are an increasing problem in lowand middle income countries.[1,2] An important component of care for noncommunicable diseases is the quality use of medicines – that is, selecting management options wisely, choosing suitable medicines if a medicine is considered necessary and using medicines safely and effectively Failure of following this component may lead to drug-related problems, which are defined as “an event or circumstance involving drug therapy that or potentially interferes with desired health outcomes.”[3] Such problems cause a large number of hospital admissions, many of which are avoidable.[4]. Findings from implementation of clinical pharmacy services in high-income countries cannot be generalizable to low- and middle-income countries

Methods

Results

Conclusion