Intensive pharmaceutical care cuts readmission rate
An intensive clinical pharmacy service can reduce hospital readmission rates, save money and can have a positive impact on the appropriateness of prescribed medicines, pharmacists in Northern Ireland have shown.
As part of a larger study, known as the integrated medicines management
programme (PJ, 13 March, p329), pharmacists at the United Hospitals Trust,
Antrim, and Queen’s University, Belfast, looked at the effect of
such a service over 16 months at three NI hospitals. A sample of 561
patients considered at risk for readmission (for example, those treated
with four or more drugs, those treated with a drug such as an angiotensin
converting enzyme
inhibitor, amiodarone, digoxin, lithium or warfarin, or those who had
been admitted to hospital in the previous six months) were
intercepted on admission and allocated to
receive either standard or intensive clinical pharmacy services until
discharge.
Presenting data from the study at a joint
meeting of the European Society
of Clinical Pharmacy and American College of Clinical Pharmacy in Paris
last week, Peter Beagon, clinical pharmacist at Antrim Area Hospital,
described the intensive clinical pharmacy service. A detailed drug history
was obtained with input from the patient, as well as from his or her
GP and community pharmacist. “This gave us a comprehensive understanding
of what the patient was taking and what the patient should have been
taking,” Mr Beagon said. And, rather than being recipients of ward-based
pharmacy services, each patient was followed closely throughout their
stay in hospital, using a bespoke approach to pharmaceutical care. On
discharge, patients were counselled about their medicines with particular
attention being paid to changes in therapy. An anonymised discharge letter
was faxed to each patient’s GP on the day of discharge.
Compared with the control group, patients receiving the intensive service
were readmitted to hospital less often during the subsequent 12 months
(of 269 patients receiving the intensive service, 107 had one or more
readmissions compared with 134 of the 292 patients offered a standard
pharmacy service).
The researchers had calculated that within the United Hospitals Trust
635 readmissions were avoidable and each avoided readmission represented
a daily €280 saving. Using the worst-case scenario of a 27-day hospital
stay, this could lead to a potential saving of over €4.8m. Mr Beagon
suggested that these
figures could be used to encourage hospital managers to invest in intensive
clinical pharmacy services. “The impact would be that health care
resources and beds are allocated more effectively, with the net result
of patients receiving treatment sooner,” he concluded.
Meetings p582 |
The
Pharmaceutical Journal
Acrobat
Reader