The impact of a hospital outreach medication review service on hospital readmission and emergency department attendances

Abstract

Background: The Monash Health Hospital Outreach Medication Review (HOMR) service is a pharmacist-led service that targets patients at high risk of medication misadventure in the immediate post-discharge period. Aim: To study the impact of a HOMR service on emergency department attendances and hospital admissions within an Australian hospital network. Method: Information was collected on the total number of emergency department attendances and hospital admissions during the 12-month period prior to, and after, the date a HOMR service was provided to the study group between 1 January 2012 and 22 November 2012. This was compared to a control group who were referred to the service and were eligible, but rejected the service. Patients were stratified by age (≤50, 51-65 and >65 years) to determine any age-related variations and tõhen investigated excluding regular, planned admissions (dialysis, chemotherapy or transfusion-related). Results: The 398 patients in the study group had a total of 1691 admissions in the 12-month period pre-HOMR. The total number of admissions in the 12-month period post-HOMR was higher than during the pre-HOMR period for both the control and study groups. When an age subanalysis was conducted and regular planned admissions were excluded, patients aged 51-65 years exhibited a 25% reduction in hospital admissions (v 2 = 6.14, p < 0.05). There was no significant reduction in admissions for the other age groups or in emergency department attendances. Conclusion: The provision of HOMR outreach services has a valuable role to play in a clearly identified population that is at high risk of medication misadventure.

Current perspectives on pharmacist home visits: do we keep reinventing the wheel?

“…The exception to this was Hanna et al, who reported an overall increase in hospital admissions; however, when they broke the study population down by age, there was a benefit of reduced hospitalizations among those aged 51–65 years. 38 Improvements in clinical and humanistic outcomes were also reported in these studies. The difference in impact of the pharmacist interventions on health care costs reported in these studies, compared with the RCTs, may be attributable to study design.…”

“… 14 – 16 , 33 , 35 , 41 , 42 , 50 , 51 , 53 In other reports, background education or experience of the pharmacists was mentio ned. 14 – 16 , 18 , 19 , 22 , 23 , 38 , 42 , 45 , 60 , 72 , 73 No comparison was done at the level of qualifications, experience, or training to outcomes. In our health authority, the pharmacists working in a home care setting as part of the Medication Management Program (MMP) must have completed an Accredited Canadian Pharmacy Residency or equivalent in order to be hired.…”

“…The most commonly studied patient population was patients who had recently been discharged from hospital. 14 , 16 , 18 , 19 , 22 , 24 , 25 , 27 – 29 , 33 , 34 , 37 , 38 , 41 , 42 , 44 , 46 , 48 , 52 , 54 , 59 , 60 , 62 , 63 , 74 – 76 Heart failure was the most commonly mentioned diagnosis. 14 , 16 , 18 , 22 , 26 , 59 , 74 , 77 While HVs can be more convenient, not all patients may want or need a HV MR. 69 Furthermore, they may have preferences for how long it should take.…”

“… 26 – 42 The majority of these studies evaluated the pharmacist HV intervention in a population of those recently discharged (acute care or skilled nursing facility). 27 – 31 , 33 , 34 , 36 – 38 , 40 , 41 , 42 Some specified patients from a primary care setting, 35 , 39 while two studies sourced patients from administrative claims data. 26 , 32 …”

“…Most of the other studies were evaluations of pharmacists conducting an HV intervention similar to the HMR, 29 , 40 except that not all reported pharmacists removed expired or discontinued medications. 26 , 35 , 38 , 40 , 42 Some authors described a MRec intervention rather than a MR. 27 , 28 , 41 …”