Integrated medicines management service may reduce hospital readmissions

An integrated medicines management service (IMMS) may reduce the number of patients readmitted to hospital with a preventable drug-related problem, according to research published in the European Journal of Hospital Pharmacy
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(online, 1 November 2016).

Researchers set out to discover the impact of an IMMS on inpatients identified as being potentially at risk of readmission because of a medicines-related issue.

The IMMS included medicines reconciliation on admission, medicine optimisation (such as stopping or starting medicines), medicines consultations, full documentation of changes to medicines and post-discharge telephone follow-up with patient and/or carers.

“This study demonstrated the financial and patient benefits of the service and adds weight to the suggestion that IMMS-style support should become more widely available to hospitalised patients to reduce risk of preventable medicines-related readmission within 30 days of hospital discharge,” the researchers write.

As part of the pharmacy service provided at London North West Hospital Trust, 744 inpatients were identified as possibly being at risk from a medicines-related readmission within a month of being discharged and were referred to the IMMS. A total of 119 (16%) of these inpatients were readmitted within 30 days of discharge, two (0.3%) of whom were back in hospital because of an avoidable drug-related issue.

The researchers point out that approximately 5–20% of hospital admissions are related to medicines, and half of these are considered preventable. Therefore, they extrapolate that between 18 (2.4%) patients and 74 (10.0%) patients would be likely to be readmitted with a preventable drug-related problem during the evaluation period.

“An IMMS team may be an effective method of reducing preventable medicines-related readmission,” the researchers write. “Further work is needed to establish the cost-effectiveness of the service.”

The researchers found that the main reason for an IMMS referral — 26% of referrals — was for a discussion with the pharmacy team about a medicines compliance aid; another 21% had identifiable adherence issues, the study found.

Some 84% of interventions by the IMMS team involved a consultation — 50% with the patient’s community pharmacist and 32% with the patient’s GP surgery.

The IMMS costs £49,974 per year to run. A hospital pharmacist will spend around four hours with each patient referred to the service.

The researchers calculated that a district general hospital IMMS could expect to take 460 referrals in a year, and only one patient would be likely to be readmitted within 30 days of discharge for a preventable medicines-related issue.

More than 95% of patients seen by the IMMS team were older people (most were aged over 70 years) and, after review, were taking between seven and nine medicines.

The average length of stay on older people wards is 19 days, at a daily cost of £444. Therefore, one preventable medicines-related readmission costs £8,436 per patient, the researchers calculated.

Lead researcher Nina Barnett, consultant pharmacist for care of older people at Northwick Park Hospital, Harrow, says: “We expected the service to be more time-consuming than it was. We also found that experienced pharmacists were able to undertake the service with minimal training.”

The research illustrates the potential of pharmacists to work with patients and their carers before discharge, says Barnett. She adds: “This shows us how important it is to maintain communication with patients once they have left hospital, including referral to community pharmacists for [the] new medicine service and for [a] medicines use review, as well as referral to other health and social care professionals in order to maintain good pharmaceutical care.”

Commenting on the findings, David Wright, professor of pharmacy practice at the University of East Anglia, says well-designed interventions that are used optimally should improve outcomes and reduce unplanned emergency admissions.

But he adds: “Evidence suggests that medicines-related problems may take a while to manifest and consequently a 30-day follow up may not provide a full picture.

“The effect of the service may not therefore be fully captured in this study. Furthermore, if researchers want to demonstrate the true value of a service then all costs and effects associated with service delivery and outcomes must be identified, measured and valued using standardised methods recognised by health economists.”

Wright says the research provides a model that is worthy of “rigorous testing” to determine its actual cost-effectiveness and adds: “The data related to costs within this study is limited and would be viewed with some caution by commissioners.”