A novel approach to medicines optimisation post-discharge from hospital: pharmacist-led medicines optimisation clinic
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RESEARCH ARTICLE
A novel approach to medicines optimisation post‑discharge from hospital: pharmacist‑led medicines optimisation clinic Mohanad Odeh1,2 · Claire Scullin3 · Anita Hogg3 · Glenda Fleming3 · Michael G. Scott3 · James C. McElnay2 Received: 21 November 2019 / Accepted: 11 May 2020 © The Author(s) 2020
Abstract Background There is a major drive within healthcare to reduce patient readmissions, from patient care and cost perspectives. Pharmacist-led innovations have been demonstrated to enhance patient outcomes. Objective To assess the impact of a post-discharge, pharmacist-led medicines optimisation clinic on readmission parameters. Assessment of the economic, clinical and humanistic outcomes were considered. Setting Respiratory and cardiology wards in a district general hospital in Northern Ireland. Method Randomised, controlled trial. Blinded random sequence generation; a closed envelope-based system, with block randomisation. Adult patients with acute unplanned admission to medical wards subject to inclusion criteria were invited to attend clinic. Analysis was carried out for intention-to-treat and per-protocol perspectives. Main Outcome Measure 30-day readmission rate. Results Readmission rate reduction at 30 days was 9.6% (P = 0.42) and the reduction in multiple readmissions over 180-days was 29.1% (P = 0.003) for the intention-to-treat group (n = 31) compared to the control group (n = 31). Incidence rate ratio for control patients for emergency department visits was 1.65 (95% CI 1.05–2.57, P = 0.029) compared with the intention-to-treat group. For unplanned GP consultations the equivalent incident rate ratio was 2.00 (95% CI 1.18–3.58, P = 0.02). Benefit to cost ratio in the intention-to-treat and per-protocol groups was 20.72 and 21.85 respectively. Patient Health Related Quality of Life was significantly higher at 30-day (P 0.05). The clinic intervention resulted in a reduction in the number of unplanned GP consultations. The risk was reduced by 47% (RR = 0.53, 95% CI 0.27–1.07) for the ITT group, and 54% (RR = 0.46, 95% CI 0.21–1.02) for the PP group. The latter risk reduction demonstrated a borderline significant value (P = 0.054). The number needed to treat was calculated at 3.82 patients (95% CI 2.00–43.47) in the PP group. Table 4 also shows that the Incidence Rate Ratio was 1.65 (95% CI = 1.05–2.57; P = 0.029) for ED visits using the ITT data. The prediction model had an acceptable fit to the data (Omnibus Test, P = 0.026). Results for the PP group were as follows: the IRR was 2.12 (95% CI = 1.27–3.52;
International Journal of Clinical Pharmacy Table 5 Resource use and cost–benefit analysis using the median data in the study
Resources use Hospital unplanned readmissionsa Emergency Department v isitb Unplanned GP consultationc
Control (Rate of patients, ITT (Rate of patients, Median number of events) Median number of events)
Difference PP (Rate of patients, Median number of events)
Difference
Rate = 35.5%, M = 2 £1,920.55 Rate = 54.8%, M = 2 £178.65 Rate = 48.4%, M = 1 £19.24 £2
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