Pharmacist-led medicines optimisation may reduce readmissions to hospital, study finds

Patient readmissions to hospital after discharge could be reduced by pharmacist-led medicines optimisation clinics, a study has found.

A pharmacy technician dispensing medicines

Attending a pharmacist-led medicines optimisation clinic (MOC) after hospital discharge could help to reduce patient readmissions, visits to A&E and unplanned GP consultations, a study published in the International Journal of Clinical Pharmacy (11 June 2020) has found.

The study, which focused on patients at high risk of medicine-related problems after hospitalisation, was designed as a parallel group, randomised controlled trial, and 62 adult patients who had been admitted to hospital were allocated to either the intervention group or the control group in a 1:1 ratio.

During their hospital stay, all patients were asked to complete three questionnaires on medication adherence, their beliefs about medicines and health-related quality of life. They were then sent the same questionnaires at 30, 90, 180 and 365 days after discharge.

For the intervention group, the MOC was conducted at the study-site hospital within two weeks of discharge and the clinical pharmacist ensured that each patient received a set range of services including medicines reconciliation, medicines review, lifestyle advice and assessment of medication adherence. Each patient took away a leaflet on action they could take at home and was invited to a follow-up within six to eight weeks.

Control patients received normal post-discharge care which did not involve any follow-up by a hospital-based clinical pharmacist.

The researchers found that none of the patients in the intervention group were readmitted to hospital within 30 days, compared to 16.1% in the control group. However, owing to the small sample size of the study, the difference failed to reach statistical significance.

However, using an intention-to-treat approach, the researchers calculated that the readmission rate reduction at 30 days for the intervention group was 9.6% (P = 0.42), and the reduction in multiple readmissions over 180 days was 29.1% (P = 0.003), compared to the control group.

The study also showed that clinic attendance decreased both A&E visits and unplanned GP consultations.

The MOC also had a positive impact on patient beliefs about their medicines and medication adherence and patient health-related quality of life was significantly higher at the 30-day, 90-day and 180-day time points in the intervention group.

Alice Oborne, consultant pharmacist in safe medication practice and medicines safety officer at Guy’s and St Thomas’ NHS Foundation Trust, said that the study “added to the body of evidence” supporting clinical pharmacist review of clinical data.

“Individual optimisation of patients’ medication is internationally recognised as key to improving patient outcomes,” she said.

Oborne added that it would be useful to understand the reasons why 80% of the 1,640 patients initially screened for the study were deemed ineligible to be included in the final study, and the level of acceptance of medication-related advice to GPs and the hospital consultants, which, she said, could inform the lack of change in the primary outcome.

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Citation
The Pharmaceutical Journal, PJ, June 2020, Vol 304, No 7938;304(7938):DOI:10.1211/PJ.2020.20208080