Projects per year
Abstract
Background:
The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist delivered service was undertaken.
Method:
Patients were recruited seven days a week from five adult medical wards in one hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay(LOS), quality of life (EQ-5D-3L), unintentional discrepancies(UDs) and emergency re-admission(ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention associated resources was determined.
Result:
200 patients were randomised to either intervention or control. Groups were comparable at baseline.95(99%) of patients in the intervention received MR within 24 hours, whilst 62(60.8%) of control patients received MRat some point during admission. The intervention resolved 250 of the 255 UDs identifed at admission. Only 2 UDs were identifed in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%,respectively. Assuming 5% loss to follow up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3 month ER rates.
Conclusions:
The results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted.
The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist delivered service was undertaken.
Method:
Patients were recruited seven days a week from five adult medical wards in one hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay(LOS), quality of life (EQ-5D-3L), unintentional discrepancies(UDs) and emergency re-admission(ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention associated resources was determined.
Result:
200 patients were randomised to either intervention or control. Groups were comparable at baseline.95(99%) of patients in the intervention received MR within 24 hours, whilst 62(60.8%) of control patients received MRat some point during admission. The intervention resolved 250 of the 255 UDs identifed at admission. Only 2 UDs were identifed in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%,respectively. Assuming 5% loss to follow up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3 month ER rates.
Conclusions:
The results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted.
Original language | English |
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Article number | e01364 |
Journal | BMJ Open |
Volume | 7 |
Issue number | 3 |
DOIs | |
Publication status | Published - 1 Mar 2017 |
Profiles
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Garry Barton
- Norwich Medical School - Professor
- Population Health - Member
- Health Economics - Member
- Health Services and Primary Care - Member
- Norwich Clinical Trials Unit - Member
Person: Research Group Member, Research Centre Member, Academic, Teaching & Research
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James Desborough
- School of Chemistry, Pharmacy and Pharmacology - Associate Professor
- Innovations in Pharmacy Education - Member
- Patient Care - Member
Person: Academic, Teaching & Scholarship, Research Group Member
-
Projects
- 1 Finished