Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial.
Aged
Aged, 80 and over
Emergency Service, Hospital
/ statistics & numerical data
Female
General Practitioners
Health Care Costs
Heart Failure
/ epidemiology
Humans
Male
Medication Reconciliation
Middle Aged
Models, Organizational
Patient Readmission
/ statistics & numerical data
Pharmacists
Primary Health Care
/ standards
Professional Corporations
/ organization & administration
Prospective Studies
Pulmonary Disease, Chronic Obstructive
/ epidemiology
Quality of Life
Queensland
Continuity of patient care
General practice
Pharmacy
Primary care
Journal
The Medical journal of Australia
ISSN: 1326-5377
Titre abrégé: Med J Aust
Pays: Australia
ID NLM: 0400714
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
30
03
2020
accepted:
15
09
2020
pubmed:
14
2
2021
medline:
24
3
2021
entrez:
13
2
2021
Statut:
ppublish
Résumé
To investigate whether integrating pharmacists into general practices reduces the number of unplanned re-admissions of patients recently discharged from hospital. Stepped wedge, cluster randomised trial in 14 general practices in southeast Queensland. Adults discharged from one of seven study hospitals during the seven days preceding recruitment (22 May 2017 - 14 March 2018) and prescribed five or more long term medicines, or having a primary discharge diagnosis of congestive heart failure or exacerbation of chronic obstructive pulmonary disease. Comprehensive face-to-face medicine management consultation with an integrated practice pharmacist within seven days of discharge, followed by a consultation with their general practitioner and further pharmacist consultations as needed. Rates of unplanned, all-cause hospital re-admissions and emergency department (ED) presentations 12 months after hospital discharge; incremental net difference in overall costs. By 12 months, there had been 282 re-admissions among 177 control patients (incidence rate [IR], 1.65 per person-year) and 136 among 129 intervention patients (IR, 1.09 per person-year; fully adjusted IR ratio [IRR], 0.79; 95% CI, 0.52-1.18). ED presentation incidence (fully adjusted IRR, 0.46; 95% CI, 0.22-0.94) and combined re-admission and ED presentation incidence (fully adjusted IRR, 0.69; 95% CI, 0.48-0.99) were significantly lower for intervention patients. The estimated incremental net cost benefit of the intervention was $5072 per patient, with a benefit-cost ratio of 31:1. A collaborative pharmacist-GP model of post-hospital discharge medicines management can reduce the incidence of hospital re-admissions and ED presentations, achieving substantial cost savings to the health system. Australian New Zealand Clinical Trials Registry, ACTRN12616001627448 (prospective).
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
212-217Subventions
Organisme : Brisbane South PHN
Organisme : HCF Research Foundation
Organisme : Brisbane North PHN
Informations de copyright
© 2021 AMPCo Pty Ltd.
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