Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study

Abstract

BackgroundIn-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.ObjectiveTo determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.DesignPropensity score-matched cohort study.SettingOntario, CanadaParticipantsPatients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.ExposureMedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.Main outcomeThe primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.ResultsMedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93–0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).Conclusions and relevanceAmong older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.

Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system

“… 45 Utilization of these services to target those most likely to benefit overall, such as older adults or people taking numerous medications, has been mixed, yet recent Canadian research has demonstrated that medication reviews are associated with a small reduced risk of readmissions to hospital and death. 44 , 46 , 47 …”

Development of an informational support questionnaire of transitional care for aged patients with chronic disease

“…12 13 However, some researchers have pointed out that aged patients with chronic diseases who received transitional care are still adversely affected as a result of low intensity of information support in transitional care. [14][15][16] These patients, who are repeatedly transferred from hospitals to their homes often do not get high-quality information support; resulting Open access in a poor quality of continuing care, especially in medication information and discharge plan implementation. [17][18][19][20] Therefore, for this special vulnerable group, we need to ensure high-intensity information support in carrying out their transitional care.…”

A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why?

“…Although most jurisdictions supporting medication reconciliation or MR for people moving from hospitals into the community provide procedural guidance on how to conduct a reconciliation or review, the reality of practice introduces variations. 15 16 Results from individual studies vary significantly, some indicating that MR after hospital discharge may have benefit in reducing hospital readmissions or emergency hospital visits, [17][18][19][20] others casting doubt that tangible outcome benefits can be achieved 21 or producing evidence of a negative effect. 22 23 The majority of studies and subsequent systematic reviews focus on outcomes as a result of an MR, they provide limited detail as to how these outcomes have been achieved or explore the differing contexts that may have led to contradictory results.…”