None listed
Conditions
Brief summary
The transition of patients with chronic and complex conditions from hospital back into the community setting is a critical time with an increased risk of medication misadventure and re-hospitalisation. AIM: The aim of this study is to investigate whether a model of structured GP and pharmacist care reduces unplanned hospital readmissions in patients taking multiple medicines. METHOD: This study will include 2240 people who have been discharged from hospital taking 5 or more medicines and attend an enrolled medical centre. Participants will be recruited at discharge from hospital and the intervention will be in 14 different medical centres across South East Queensland. Depending on when the participant is discharged, they will be placed in the control or intervention phase. Participants in the control phase will receive usual care from their medical centre. This means the patient would consult their GP as per normal standards for that practice for a patient discharged from hospital. Participants in the intervention phase will be followed up after discharge by a pharmacist working in the medical centre they attend. The practice pharmacist will organise a time for the participant to come into the medical centre and to discuss the changes made during their hospital stay and review the participant’s medicines. After a consultation with the pharmacist, the participant will have a consultation with their GP to receive any new scripts they may need and to consider any changes recommended by the hospital or pharmacist. The practice pharmacist will follow up with the participant within five days of the first consultation. The practice pharmacists may also contact other health professionals involved in the participant's care as required. It is hoped that a pharmacist and GP reviewing a patient’s medicines and changes made during hospital will reduce the likelihood of the patient being readmitted to hospital.
Interventions
The intervention is a multi-faceted and collaborative service, involving a clinical pharmacist integrated into a medical centre to assist patients in transitioning back into primary care. The intervention is targeted at the level of the medical centre. A practice pharmacist will be co-located in each medical centre during the intervention phase for approximately 12 hours per week. The length of time a medical centre receives the intervention will depend on where they are randomised to in the ste
The intervention is a multi-faceted and collaborative service, involving a clinical pharmacist integrated into a medical centre to assist patients in transitioning back into primary care. The intervention is targeted at the level of the medical centre. A practice pharmacist will be co-located in each medical centre during the intervention phase for approximately 12 hours per week. The length of time a medical centre receives the intervention will depend on where they are randomised to in the stepped wedge design, from one month to seven months. There will be four components to the intervention which will apply to each patient enrolled in the study during the intervention phase: 1. Medication management consultation with practice pharmacist 2. Consultation with GP 3. Practice pharmacist to follow-up with patient, GP, community pharmacy and other health professionals involved in the patient’s care 4. Further follow-up as required Medication management consultation: Participants will receive a face-face minute medication management consultation (45 - 60 minutes) with the practice pharmacist in a private room at the attended medical centre as soon as possible after discharge from hospital. During this time, the pharmacist will perform a comprehensive medication review to identify any medication-related problems, assess medication adherence, review the participant’s medication discharge letter and discuss any changes made to medication during hospital admission with the participant. The pharmacist will also review the participant’s medical records at the practice and reconcile any differences as required. The pharmacist will discuss the intended treatment plan and any problems or concerns the participant may have regarding their medication and/or medical conditions. The pharmacist may also liaise with the participant’s community pharmacy as required . Consultation with GP: Directly after the consultation with the pharmacist, the patient will have a consultation with their GP to and to consider any changes made by the pharmacist or hospital during the admission, discuss the recent admission from hospital and future management plans. This will take 15 - 30 minutes. Follow up : The pharmacist will follow up with the participant within five days either via the phone or face-to-face at the attended medical centre (10-30 minutes). Furthermore, the pharmacist will liaise with the participant’s GP, other prescribers and community pharmacist based upon clinical need. Further follow up will be based upon clinical need.
Sponsors
Christopher Freeman
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
*Prescribed 5 or more long-term prescribed medicines on discharge OR reason for admission was related to heart failure or Chronic Obstructive Pulmonary Disease (COPD) *Have nominated a GP working in an enrolled medical centre in their hospital records which they see majority of the time.
Exclusion criteria
Patients will be excluded if they are: *Receiving active radiation therapy or chemotherapy for malignant conditions *Admission was for planned dialysis *In palliative care as reflected by the treatment regimen (e.g. cessation of preventative medicines) *Unable to attend a medication review and the follow up within the time frame
Outcome results
None listed