Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service

• Published in: BMC geriatrics Vol. 23; no. 1; p. 183
• Main Authors: Basger, Benjamin Joseph, Moles, Rebekah Jane, Chen, Timothy Frank
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.03.2023; BioMed Central; BMC
• Subjects: Admission and discharge; Aged; Caregivers; Drug dosages; Drug stores; Education; Ethics; Geriatrics; Hospitals; Humans; Inappropriate medicine use; Intervention; Medicine; Medicine related problems; Medicine review; Methods; Older people; Palliative care; Patient centred care; Patient Discharge; Patient safety; Patient satisfaction; Patient-Centered Care; Patients; Pharmacists; Polypharmacy; Practice; Prescription drugs; Primary care; Reconciliation; Retrospective Studies; Services; Transitional care; Transitions of care; Australia; Polypharmacy; Transitions of care; Inappropriate medicine use; Medicine related problems; Deprescribing; Implementation; Medicine review; Patient centred care
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-023-03921-2

Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12 July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .