A novel approach to medicines optimisation post-discharge from hospital: pharmacist-led medicines optimisation clinic

• Published in: International journal of clinical pharmacy Vol. 42; no. 4; pp. 1036 - 1049
• Main Authors: Odeh, Mohanad, Scullin, Claire, Hogg, Anita, Fleming, Glenda, Scott, Michael G., McElnay, James C.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2020; Springer Nature B.V
• Subjects: Aged; Ambulatory Care - organization & administration; Cardiology; Discharge planning; Disease management; Drug stores; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Ethics; Female; Health care; Hospitals; Humans; Innovations; Internal Medicine; Male; Medical innovations; Medical research; Medication Adherence - psychology; Medicine; Medicine & Public Health; Northern Ireland; Outcome Assessment, Health Care; Patient compliance; Patient Discharge; Patient Readmission - statistics & numerical data; Patient satisfaction; Patients; Pharmaceutical Services - organization & administration; Pharmacists - organization & administration; Pharmacy; Practice research; Professional Role; Quality of Life; Questionnaires; Reconciliation; Research Article; Northern Ireland; Cost perspective; Medicines optimisation clinic; Pharmacist-led services; Patient care; United Kingdom; Readmission; Medicine review
• ISSN: 2210-7703; 2210-7711; 2210-7711
• DOI: 10.1007/s11096-020-01059-4

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.