3 Impact of an Integrated Medicines Management (Imm) Service on Preventable Medicines Related Readmission (Pmrr) to Hospital

Abstract

Topic: Medication contributes to 5-20% of hospital admissions of which half are preventable (Pirmohamed M et al BMJ. 2004;329:15-19). Avoidable medicines related harm in England was estimated for 2014 as £1-£2.5bn. In 2010 the Department of Health issued guidance that NHS Trusts would no longer be fully reimbursed for emergency readmissions within 30 days of discharge, making reducing preventable medicines related readmission (PMRR) a priority.The National Service Framework for Older People (2001 London: Department of Health) promoted medication review to reduce adverse effects and PMRR for patients. This parallel cohort study investigates the effect of pharmacy-led IMM service on the rate of PMRR at Northwick Park Hospital site (NPH) compared with a traditional UK hospital pharmacy service at Central Middlesex hospital site (CMH).Intervention: Health care professionals identified patients at risk of PMRR using the PREVENT© checklist (Barnett NL et al. Pharm J 2011;286:471-2) and referred them to the integrated medicines management (IMM) pharmacist team for medicines reconciliation, review, consultations, discharge planning and post discharge follow up as appropriate. 744 NPH patients were identified between October 2008-October 2014 and 92 patients CMH patients between February-October 2014. Improvement: At NPH 119/744 (16%) patients were readmitted within 30 days of discharge and 2 (0.3%) had a PMRR. At CMH, 17/92 (18%) patients were readmitted within 30 days of discharge and 4 had a PMMR (4.4%). Fischer's exact test was used to compare groups and the difference was statistically significant (P = 0.002). A saving £3 for every £1 spent on an IMM pharmacist suggests rollout can reduce cost for the health economy. Discussion: Literature and case review and collaborative cross-sector professional working facilitated implementation. Regular frequent ( planned and unplanned) turnover of clinical staff presented challenges around ensuring staff were aware of the service and how to refer. The service has been successfully replicated in Europe and Scandinavia (Scott M et al Eur J Hosp Pharm 2015 doi:10.1136/ejhpharm-2014) demonstrating feasibility of replication. Absence of community pharmacy follow up may present implementation challenges in some settings. Data collection from both sites at service commencement would have been beneficial. Future work will include exploration of patient experience, admission coding to identify high risk patients on admission and developing further links with primary care to identify and manage high risk patients in the community.i1 Age and Ageing 2016; 45: i1-i9

Trends in emergency hospital admissions in England due to adverse drug reactions: 2008-2015

“…Patients identified as high‐risk receive enhanced clinical pharmacy input during their hospital stay and post‐discharge support if required. A case–control study of 836 patients found that there was a statistically significant reduction in medicines‐related readmissions in patients receiving this service ( P < 0.002) . A similar integrated medicines management model in Sweden has also demonstrated a statistically significant reduction in medication‐related hospital admissions and associated cost savings …”