Authors (including presenting author) :
Ip NS(1)(3), Chu CK(2), Chu LM(1), Young WM(1), Justin WT(3)
Affiliation :
(1)Department of Pharmacy, (2)Department of Medicine and Geriatrics, Tuen Mun Hospital; (3)School of Pharmacy, The Chinese University of Hong Kong
Introduction :
Patients in rehabilitation setting experience numerous medication changes during care transitions, exposing them to an increased risk of drug-related problems (DRPs). Elderly patients with heart failure (HF), acute coronary syndrome (ACS), and stroke are particularly vulnerable due to complex medical histories and polypharmacy. The role of pharmacists in improving quality use of medications has been recognized worldwide. However, there have been no local studies evaluating the impact of pharmacist service in rehabilitation settings.
Objectives :
To evaluate the impact of pharmacist discharge service on 30-day unplanned healthcare utilization and medication adherence for high-risk patients
Methodology :
A prospective, non-randomized study was conducted in medical rehabilitation wards in Tuen Mun Hospital in late 2017. Patients aged ≥65 years old who hospitalized for HF/ACS/stroke and discharged with ≥5 routine oral medications were included. Patients were divided into intervention group and usual care group. For intervention group, a pharmacist provided medication reconciliation, medication review and drug counseling before patient discharge. The clinical significance of identified DRPs was assessed by two independent clinical pharmacists. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale. Phone follow-up was carried out at 30 days after discharge to assess for unplanned healthcare utilization rate (a composite of unplanned hospital readmissions/emergency department visits) and post-counseling medication adherence. No direct patient care was provided to usual care group.
Result & Outcome :
A total of 85 patients (n=43 in intervention group, n=42 in usual care group) were included. Among intervention group, 23 DRPs were identified in 14 patients (32.6%) and resulted in 51 interventions. The acceptance rate of pharmacist interventions was 94.1%. All identified DRPs were rated “somewhat significant” to “significant”. Intervention group had a lower rate of 30-day all-cause unplanned healthcare utilization than usual care group (25.6% vs. 47.6%, p=0.035). Pharmacist service was associated with a 60% reduction in 30-day unplanned healthcare utilization (OR=0.378, 95% CI=0.15-0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p<0.05). Pharmacist medication reconciliation and discharge counseling was associated with lower odds of 30-day unplanned healthcare utilization, which reached statistical significance and improved patient medication adherence among elderly patients with cardiovascular/ cerebrovascular diseases in rehabilitation setting.
Co-location with:
