Post discharge medicines use review service for older patients: recruitment issues in a feasibility study

Abstract

Abstract:Abstract Background The community pharmacy Medicines Use Review (MUR)service in England has been identified as a way of providing support with medication to recently discharged patients; however initial uptake of post-discharge Medicines Use Reviews has been low. Objective To identify barriers to recruitment into a randomised controlled feasibility study of a hospital referral system to older patients' regular community pharmacists. Method Ward pharmacists at Southport District General Hospital identified patients aged over 65 to be approached by a researcher to assess eligibility and discuss involvement in the trial. Participants were randomised to referral for a post discharge MUR with their regular community pharmacist, or to standard discharge care. Reasons for patients not participating were collected. Results Over a 9-month period 337 potential participants were identified by ward pharmacists. Of these, 132 were eligible and 60 were recruited.

Community pharmacist perceptions of delivering post-hospital discharge Medicines Use Reviews for elderly patients

“…housebound patients). The uncertainty of older patients in their ability to leave home to attend a dMUR in the early post discharge period, exacerbated by a lack of perceived benefit, was also a barrier in the initial recruitment of patients to the referral service [6]. Indeed the intention was to screen out such patients at the recruitment stage.…”

“…HR would normally visit the patient within 24 hours of this initial recruitment screen to assess fully patient eligibility for recruitment to the study. Inclusion and exclusion criteria were largely dictated by the NHS England service specifications for MUR and the practicalities of delivering the service and have previously been reported [3,6].…”

Evaluating the impact of the Eastern Academic Health Science Network Transformation Support Unit

“…Improved discharge medical information has the potential to reduce unintended medication changes, patient harm and hospital readmissions (Ramsbottom et al, 2016). Nazar et al (2016) studied 2,029 hospital patients in Newcastle-upon-Tyne who received electronic referrals to CPs for a consultation following discharge from hospital over a oneyear period in 2014/15.…”

“…A larger-scale study with a longer follow-up period would be needed to better understand how the intervention works. Ramsbottom et al (2016) evaluated the impact of a post-discharge medicines use review (dMUR) service by CPs for older patients by randomising 30 participants to receive either a dMUR or standard discharge care (Ramsbottom et al, 2016). The dMUR service involves a face-to-face consultation between the patients and CPs, which provides information on medications and side effects, offers compliance aid and lifestyle advice, etc.…”

“…The study population was different though, since the sample was limited to patients aged 80 and over, while Ramsbottom et al (2016) included all patients aged 65 and above. There might be heterogeneous effects across different subgroups of patients.…”