24 February 2021

Fewer ED visits after medication reviews

General practice Hospitals Pharmacy

Australian patients with complex medication needs are less likely to present to an emergency department after hospital discharge if reviewed by a pharmacist in primary care, prompting calls to strengthen GP-pharmacist relationships.

The study, led by University of Queensland Associate Professor and pharmacist Christopher Freeman, supported increased pharmacist input – such as domiciliary medication management reviews (DMMRs) – for patients discharged from hospital on multiple medications.

Professor Freeman told TMR that the knowledge sharing brought about by this closer working relationship was especially useful in medication management reviews.

“[When they work together, it is] much easier for the GP and pharmacist to have a conversation around the patient’s health and conditions,” he said.

“All the tacit knowledge the GP accumulates over many years of seeing the patient can be then relayed to the pharmacist in the context of reviewing their medications.”

This more informal information exchange, according to Professor Freeman, occurs only rarely when a patient is referred for a DMMR.

Baseline data shows almost half of patients do not follow medication changes initiated while in hospital, leaving them – especially patients on five or more medicines – at high risk of readmission.

While there is already strong evidence showing the clinical benefits of integrating pharmacists into general practice teams, little is known about the specific benefits their presence in primary care may have on hospital readmissions and ED presentations.

Previous studies have looked at pharmacist-led interventions administered by a hospitalbased pharmacist in patient homes, outpatient clinics and via telehealth. All have returned mixed results.

In this study, Professor Freeman and colleagues followed two groups of Queensland-based patients for one year after they were prescribed five or more long term medications on discharge from hospital, with one group receiving a medication review by a pharmacist within seven days of discharge, and the other group receiving none.

After conducting the medication intervention, pharmacists discussed outcomes with the patient’s regular GP, who followed up with the patient shortly after.

The control group consisted of 177 patients, and the intervention group consisted of 129 patients.

Patients who received the pharmacist medication review were half as likely as their peers to present to hospital ED, and significantly less likely to require readmission in the 30 days following discharge.

When looking at the whole 12 months, however, the intervention group was not significantly less likely to require readmission; this led the authors to call for future studies exploring the effect of regular medication management reviews.

“The benefits of our intervention may be related to the timely and coordinated care provided by the pharmacist consultation, linked closely with GP review and engagement, whereby the clinical rapport and trust between the co?located practitioners, not a feature of some studies, encourages implementation of pharmacists’ recommendations,” the authors wrote in the MJA.

Patients who received the intervention are estimated to have saved the public health system roughly $5,000 each, thanks largely to fewer ED presentations.

Professor Freeman called for the integration of pharmacists in general practice and welcomed recently widened guidelines around which allied health professionals can be included in the primary care workforce incentive program.

Nevertheless, he acknowledged that many practices do not have the financial resources to achieve this and there were no signs of government funding to properly integrate pharmacists on the horizon.

“If the intent [of the government] is to try and move toward a team-style approach to managing patient care, then it needs to be better supported from a financial perspective,” Professor Freeman told TMR.

MJA, 10 February 2021

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