Feasibility and Timeliness of Alternatives to Post‐Discharge Home Medicines Reviews for High‐Risk Patients

Abstract

Background The period 7 to 10 days following hospital discharge is associated with a significant risk of medication misadventure, especially in high‐risk patients. Aim To investigate whether post‐discharge hospital‐initiated medication review (HIMR) pathways are more timely than the post‐discharge home medicines review (HMR) pathway. Method An implementation study conducted over 9 months in 2008/2009 of patients from 3 South Australian hospitals. A risk stratification instrument was used to identify patients at “high” risk of medication misadventure. Feasibility was assessed and time to conduct the post‐discharge medication reviews was determined for the HMR and HIMR pathways. Results Of the 97 consenting patients, 92 were stratified as “high” risk. HIMR were organised for 59 patients − 52 patients completed the HIMR process. Of the 22 HMRs organised via the patient's general practitioner, 18 patients completed the HMR process. The time from request to conducting the HIMR and HMR were statistically significantly different – HIMR and HMR took 6.5 ± 4.7 days and 11 ± 7.4 days, respectively (p = 0.02). Conclusion This study has demonstrated the feasability of alternative pathways to post‐discharge medication reviews. The HIMRs were conducted sooner than HMRs organised via existing community processes. If post‐discharge medication reviews are organised via the HIMR pathway, there is potential to reduce medication misadventure in high risk patients in a more timely manner than when post‐discharge HMRs are organised.

Clinical medication review in Australia: A systematic review

“…65,79 Key processes A range of CMR models were evaluated. This included CMRs which involved pharmacist 22,44,53 Findings of qualitative work also supported these referral pathways, with stakeholders highlighting the use of pharmacists, nursing staff and other health providers as sources for CMR referrals. 63,64 Studies also reported CMRs undertaken by an accredited pharmacist working in a medical practice, 10,33,42,45 or as part of an ACAT (n ¼ 2), 23,51 community mental health team (n ¼ 1), 35,63 or palliative care team (n ¼ 1).…”

“…10,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44][46][47][48][49][50][52][53][54][55][56][57][58][59][60][61] Some studies investigated CMR in particular demographic groups including older people (R65 years, n ¼ 10) 24,31,[45][46][47][48]51,[55][56][57] and war veterans, widows and dependents (n ¼ 5). 52,[55]…”

“…36 Patients admitted to or recently discharged from hospital were also targeted for CMR post-discharge (n ¼ 12). 20,22,26,28,32,38,39,41,44,53,56,61 Polypharmacy was a common eligibility criteria (n ¼ 6), 20,[23][24][25][26]58 with eligibility criteria ranging from current use of two to greater than 20 subsidized prescriptions in the previous six months. The impact of CMR in patients taking specific medications was investigated, including those on warfarin (n ¼ 3), 28,41,57 anti-diabetic medications (n ¼ 2), 25,26 and other high-risk medications (n ¼ 1).…”

Embedding the clinician-researcher pharmacist in healthcare

“…The patients selected by the clinical pharmacists were deemed high risk, in both time periods, for medicine misadventure. 319,320 The accuracy of the MITF has improved, while the timeliness decreased from 100% in 2009 to 93% in 2014. Of the five MITF's which were outside the 48 hours, all were sent within 7 days' post-discharge.…”

“…In Australia, new funding is expected to be available for hospital pharmacists, GP's and community pharmacists to deliver a comprehensive medicines discharge process, including a Hospital Initiated Home Medicines Review. 319 Developing the relationships between community pharmacists, hospital pharmacists, medical practitioners, health clinic staff and engaging patients, will be critical success factors.…”