Feasibility and timeliness of alternatives to post-discharge home medicines reviews for high-risk patients

Abstract

Background: The period 7 to 10 days following hospital discharge is associated with a significant risk of medication misadventure, especially in high-risk patients. Aim: To investigate whether post-discharge hospital-initiated medication reviews (HIMRs) are more timely than postdischarge home medicines reviews (HMRs). Method: An implementation study was conducted over 9 months (2008/2009) at 3 hospitals in South Australia. A risk stratification instrument was used to identify patients at 'high' risk of medication misadventure. Feasibility was assessed and time to conduct post-discharge medication reviews was determined for the HMR and HIMR pathways. Results: Of the 97 consenting patients, 92 were considered 'high' risk. HIMRs were organised for 59 patients and 52 patients completed the HIMR process. Of the 22 HMRs organised via the patient's general practitioner, 18 patients completed the HMR process. The time from request to conducting HIMRs and HMRs were statistically significantly different - HIMRs and HMRs took 6.5 plus or minus 4.7 days and 11 plus or minus 7.4 days, respectively (p = 0.02). Conclusion: This study has demonstrated the feasibility of alternative pathways to post-discharge medication reviews. HIMRs were conducted sooner than HMRs organised via existing community processes. Medication misadventure in high-risk patients can be reduced in a more timely manner if post-discharge medication reviews are organised via the HIMR pathway.