Pharmacist-led medication reviews after hospital discharge significantly cut chances of readmission

Reseach has shown that patients who did not receive a discharge medicines review had a 56% change of being readmitted to hospital within 90 days.

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Patients in Wales who had their medicines reviewed by a pharmacist after being discharged from hospital were significantly less likely to be readmitted within 90 days, compared to those who did not have a review, a study has found.

The results, published in BMJ Open on 9 February 2020, show that 977 of the 1,844 patients who were referred for a discharge medicines review (DMR) between February 2017 and April 2018 after leaving hospital were readmitted within 90 days.

Just under a third (31.4%) of those readmitted received a DMR from their pharmacist, while the majority (68.6%) did not have a DMR, despite being referred.

Analysis of the data revealed that patients who received a DMR had a 45% chance of being readmitted to hospital within 90 days, compared to a 56% chance held by those who did not.

Those who received a DMR were 14% and 13% less likely to have been readmitted at 30 and 60 days, respectively, compared to those who did not have one at all.

Commenting on the number of patients who did not receive DMRs, Efi Mantzourani, lead author on the study and senior lecturer at the Cardiff University’s School of Pharmacy and Pharmaceutical Sciences, said this “does not necessarily mean that patients who had been assigned to receive a DMR chose not to have one”.

“It could be they were not even aware they could receive one or the pharmacy team didn’t follow it through,” she said.

DMRs were introduced in Wales in 2011 and are now available in 703 community pharmacies across the country. As part of the service, community pharmacists check for discrepancies between GP prescriptions received by patients after their discharge and the list of medicines that the patient received at discharge. The pharmacist will also conduct a medicines use review to discuss any issues with adherence or side effects.

The study, which was co-authored by Cardiff University’s School of Pharmacy and Pharmaceutical Sciences, NHS Wales Informatics Service, Public Health Wales and the Welsh government, used data from patients at all 93 hospitals and all 703 community pharmacies across Wales.

Karen Hodson, senior lecturer and director of MSc in clinical pharmacy at Cardiff University, said she is “hoping that the robust evidence we are presenting in this study will demonstrate the benefit of such discharge schemes to patients”.

“To achieve the seamless communication between all sectors involved in patients’ care, a joined-up digital approach is crucial to facilitate the discharge process,” she said.

“By having systems that integrate with each other in Wales, we have removed many of the barriers that have been previously identified in literature in relation to transfer of care, such as legibility and timeliness of information, and reduction of transcription errors due to forms being automatically populated.”

Hodson added that hospital staff will be able to access completed DMR forms through the Welsh Clinical Portal from April 2020, which delivers the digital medical record for Wales “whenever [hospital staff] want to check patient outcomes”.

A similar study published in the International Journal of Pharmacy Practice
 on 4 February 2020 found that patients in Cornwall followed up by a community pharmacist after hospital discharge were significantly less likely to be readmitted within 30 days compared to patients who had not seen a pharmacist.

Last updated
The Pharmaceutical Journal, February 2020;Online:DOI:10.1211/PJ.2020.20207712