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BMJ Qual Saf. 2019 Aug 8. pii: bmjqs-2019-009545. doi: 10.1136/bmjqs-2019-009545. [Epub ahead of print]

Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study.

Author information

1
Medicine, University Health Network, Toronto, Ontario, Canada lauren.lapointe.shaw@mail.utoronto.ca.
2
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
4
ICES, Toronto, Ontario, Canada.
5
Medicine, Sinai Health System, Toronto, Ontario, Canada.
6
Institute of Health Policy, Management and Evaluation and Toronto General Research Institute, University of Toronto, Toronto, Ontario, Canada.
7
Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada.
8
Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
9
Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.
10
Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
11
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

In-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.

OBJECTIVE:

To determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.

DESIGN:

Propensity score-matched cohort study.

SETTING:

Ontario, Canada PARTICIPANTS: Patients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.

EXPOSURE:

MedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.

MAIN OUTCOME:

The primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.

RESULTS:

MedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93-0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).

CONCLUSIONS AND RELEVANCE:

Among older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.

KEYWORDS:

medication reconciliation; medication safety; transitions in care

PMID:
31395749
DOI:
10.1136/bmjqs-2019-009545

Conflict of interest statement

Competing interests: LL-S reports support from a CIHR Fellowship Award (FRN 146714), and the Philipson Scholar program at the University of Toronto. PCA is supported by a Mid-Career Investigator award from the Heart and Stroke Foundation. NMI reports support from CIHR and the Ontario Ministry of Health and Long-Term Care. DAR reports support from a Canada Research Chair in Medical Decision Science. CMB reports support from the Department of Medicine at the University of Toronto and Sinai Health System. None of these organisations had any involvement in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Immigration, Refugees and Citizenship Canada (IRCC). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of ICES, MOHLTC, CIHI or the IRCC. No endorsement by ICES, MOHLTC, CIHI or the IRCC is intended or should be inferred. The named organisations and funding bodies had no involvement in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

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