Sheridan Briggs1, Robert Pearce1, Sophie Dilworth2, Isabel Higgins2, Carolyn Hullick2,3, John Attia2,4. 1. Department of Pharmacy, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia. 2. Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia. 3. Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia. 4. Department of General Medicine, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
Abstract
OBJECTIVES: To determine if medication review by a clinical pharmacist of older patients in the ED impacted on admission to hospital and other outcomes. METHODS: A stratified, randomised controlled study comparing the intervention to current practice. A tertiary referral ED in New South Wales, Australia. Older people (>70 years) living at home who initially reported taking greater than five medications. Medication review by an experienced hospital pharmacist within the ED. Rate of admission, rate of readmission, length of stay and admission to an aged care facility at 4 months post presentation, and rate of general practitioner acceptance of pharmacist recommendations. RESULTS: The odds of admission decreased for those receiving the intervention (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.53, 0.87; P = 0.002). There was no evidence that the intervention affected hospital length of stay for admitted patients (0.09 days change, 95% CI -0.08, 0.25; P = 0.31), the rate of re-presentation (0.08% change, 95% CI -0.12, 0.28; P = 0.44) or admission to an aged care facility. The odds of admission to an aged care facility increased with the Identification of Seniors at Risk score. General practitioners adopted 49% of pharmacists' recommendations. CONCLUSIONS: The presence of an experienced pharmacist in the ED reduced hospital admissions. Further study is required to determine longer term impacts of General Medical Practitioner acceptance of pharmacists' recommendations.
RCT Entities:
OBJECTIVES: To determine if medication review by a clinical pharmacist of older patients in the ED impacted on admission to hospital and other outcomes. METHODS: A stratified, randomised controlled study comparing the intervention to current practice. A tertiary referral ED in New South Wales, Australia. Older people (>70 years) living at home who initially reported taking greater than five medications. Medication review by an experienced hospital pharmacist within the ED. Rate of admission, rate of readmission, length of stay and admission to an aged care facility at 4 months post presentation, and rate of general practitioner acceptance of pharmacist recommendations. RESULTS: The odds of admission decreased for those receiving the intervention (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.53, 0.87; P = 0.002). There was no evidence that the intervention affected hospital length of stay for admitted patients (0.09 days change, 95% CI -0.08, 0.25; P = 0.31), the rate of re-presentation (0.08% change, 95% CI -0.12, 0.28; P = 0.44) or admission to an aged care facility. The odds of admission to an aged care facility increased with the Identification of Seniors at Risk score. General practitioners adopted 49% of pharmacists' recommendations. CONCLUSIONS: The presence of an experienced pharmacist in the ED reduced hospital admissions. Further study is required to determine longer term impacts of General Medical Practitioner acceptance of pharmacists' recommendations.
Authors: Victor Johan Bernard Huiskes; David Marinus Burger; Cornelia Helena Maria van den Ende; Bartholomeus Johannes Fredericus van den Bemt Journal: BMC Fam Pract Date: 2017-01-17 Impact factor: 2.497