Implementing and Evaluating a Parallel Post-discharge Home Medicines Review (HMR) Model

Project Details
Project ID: IIG-011
Type: Investigator Initiated
Status: Completed
Institution: University of South Australia
Chief Investigator: Dr Manya Angley

Project Summary

The risk of medication misadventure is high in the 7 to 10 day period following transition from hospital to community. Post-discharge Home Medicines Reviews (HMRs) can be facilitated by hospital-based liaison pharmacists but timeliness of HMR conduction is problematic.

In 2008/2009 we trialled a post-discharge medication model that sought to enable medication reviews for ‘high’ risk patients to occur within 7 days post-discharge across 3 South Australian metropolitan hospitals. In addition to a HMR pathway it included a Hospital Initiated Medication Review (HIMR) pathway where hospital doctors referred patients directly to community or accredited pharmacists.

The HIMR pathway was activated when general practitioners (GPs) indicated a HMR could not occur within 7 days. Time to conduction to post-discharge medication reviews was determined for the HMR and HIMR pathways.

Of the 97 consenting patients, 92 patients were deemed to be at ‘high’ risk. HIMRs were organised for 59 patients; with 52 patients completing the HIMR process. Of the 22 HMRs organised via the patient’s GP, 18 patients completed the process.

The times to conduction of HIMRs and HMRs was statistically significantly different, with HIMRs and HMRs taking 6.54 ± 4.73 and 11.11 ± 7.44 days respectively (p=0.0235). This study has shown HIMRs can be facilitated in a timelier manner than post-discharge HMRs organised using existing community processes.

Conduction of reasonably timely post-discharge HMRs can occur when GPs are made aware of their urgency, patients have been identified as being at ‘high’ risk of medication misadventure by the hospital home team and GPs are supported by a liaison pharmacist.