Admissions increased by “at home” reviews
Emergency admissions to hospitals are increased by medication reviews
carried out by pharmacists in patients’ homes, according to research published
last month in the BMJ.
Researchers randomised 872 elderly patients who were discharged from
hospital after an emergency admission with two or more prescribed drugs
to receive two home visits by a pharmacist (intervention group) or their
usual care (control group). Those in the intervention group went on to
have 30 per cent more admissions to hospital and 43 per cent more home
visits by GPs than those in the control group. Quality of life measures
also decreased less in the control than the intervention group.
The researchers suggest three explanations. First, pharmacists may have
enabled patients to understand their condition better, leading to patients
being able to recognise warning signs earlier and seek help. This theory
is supported by the smaller number (albeit not significantly) of deaths
in the intervention group than the control group that was noted. Second,
pharmacists might have encouraged patients to adhere to their medication
regimens more than they otherwise would, thereby precipitating side-effects
or drug interactions. Another possibility was that having pharmacists
visit patients at home simply added to the complexity of care, increasing
the confusion and anxiety of patients.
It is not clear from the paper whether the patients in either group received
any advice about their medicines from hospital pharmacists during their
emergency admissions.
The researchers conclude that: “… a growing body of evidence
suggets that further research is necessary to elucidate the most effective
form and detailed effects of medication review. The recommendation in
the national service framework for older people that this should be widely
introduced in primary care seems to lack a clear evidence base.”
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Hospital Pharmacist