Authors (including presenting author) :
Ip NS(1), Chu CK(2), Chu LM(1), Young WM(1)
Affiliation :
(1)Department of Pharmacy, (2)Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Patients in rehabilitation setting are at increased risk of drug discrepancies and drug-related problems (DRPs) due to multiple care transitions. Pharmacists play an essential role in promoting quality use of medications. However, with limited resources, pharmacist involvement for all patients is not feasible. A prospective study in orthopedic rehabilitation wards in 2016 identified that DRPs was associated with ≥5 routine oral medications. With this result, another prospective study conducted in 2017 showed the association between pharmacist service and reduction of unplanned healthcare utilization in patients with cardiovascular/cerebrovascular diseases and polypharmacy in rehabilitation setting. Nevertheless, empirical data showing generalizability of pharmacist impact to other patients in rehabilitation setting is sparse.
Objectives :
To evaluate the impact of clinical pharmacy service on unplanned healthcare utilization and medication adherence for high-risk elderly patients in rehabilitation/convalescent setting
Methodology :
A 6-month pilot service was conducted in rehabilitation/convalescent wards from August 2018. Patients aged ≥65 years old who discharged to home with ≥5 routine oral medications were included. Pharmacist provided medication reconciliation, medication review and drug counseling before discharge. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale. Phone follow-up was carried out 30 days after discharge to assess unplanned healthcare utilization (a composite of unplanned hospital readmissions/emergency department visits) and post-counseling medication adherence. For comparison, patients discharged one year before service initiation were selected as usual care group, using the same inclusion criteria.
Result & Outcome :
After 3-month implementation, 295 patients (service group: n=130,usual care group: n=165) were included. Among service group, 33 DRPs and 18 unintentional drug discrepancies were identified in 42 patients (32.3%) and resulted in 78 interventions. The acceptance rate of pharmacist interventions was 93.2%. After logistic regression analysis, service group had lower rate of 30-day all-cause unplanned healthcare utilization (30.0% vs. 40.6%,p=0.031,adjusted OR=0.574,95% CI=0.35-0.95). Patients reporting medium to high medication adherence increased from 63.0% to 96.9% after counseling (p<0.01). Clinical pharmacy service was associated with statistically significant reductions (40%) in 30-day unplanned healthcare utilization and improvements in medication adherence, optimizing quality use of medications and health outcomes. Involvement of clinical pharmacists in medication reconciliation and drug education at discharge is an effective way to improve patient care and reduce healthcare cost due to unplanned utilization of healthcare resources.
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