Timeliness and Clinical Impact of Hospital‐Initiated Medication Reviews

Abstract

Background: Medication-related problems often occur in the immediate post-discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients' medicines in their homes. Aim: To determine if hospital-initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity-specific questions on the quality of reports. Method: Eligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post-discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance. Results: HIMRs were conducted within 11.6 ± 6.6 days postdischarge. 36 HIMR reports were evaluated and 1442 issues identified -information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised. Conclusion: HIMRs can be facilitated in a more timely manner than post-discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports. J Pharm Pract Res 2009; 39: 269-73.

Clinical medication review in Australia: A systematic review

“…1). Data were extracted from nine controlled studies (Table 1), 20-28 34 observational or uncontrolled studies with a focus on MRPs (Table 2), [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and other clinical, humanistic and economic outcomes (Table 3), 10,44-61 11 qualitative (including interviews and focus groups) and nine survey research studies (Table 4). 11,13,[62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] Methodological quality of studies…”

“…32 Three studies were excluded from this calculation due to insufficient information. [37][38][39] One study reported a mean of 7.2 'issues' per CMR for people with a mental illness, although some 'issues' were prescriber or patient-related rather than medication-related. 30 Only one study included a comparator group, finding a greater number of MRPs identified by a CMR pharmacist integrated in a GP clinic in comparison to an external CMR pharmacist (5.4 vs 3.6 MRPs per patient).…”

“…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).…”

“…Of the 15 studies specifically assessing MRPs, [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] an overall mean of 3.6 MRPs was identified per CMR. This ranged from a mean of 1.3 MRPs identified among CMR recipients in a rural community setting, 29 to 5.6 MRPs among CMR recipients discharged from a hospital cardiology ward.…”