Effectiveness of a multidisciplinary home‐based medication review program in reducing healthcare utilization among older adult Singaporeans

Aim The study aimed to: (i) evaluate the effectiveness of a multidisciplinary home‐based medication review ( HBMR ) program in reducing hospital admissions and emergency department ( ED ) visits, cost of hospital admissions and length of stay ( LOS ); and (ii) determine the prevalence of drug‐related problems ( DRP ) in elderly Singaporeans. Methods A retrospective observational study was carried out at an academic medical center in S ingapore. Patients referred between 1 M arch 2011 and 31 D ecember 2012 were included. Frequency of hospital admissions and ED visits, cost of hospital admissions, and LOS 6 months before and after HBMR , number of DRP , their categories, and their outcomes (i.e. resolved/ unresolved) were recorded. Results The analysis included 107 patients with a mean (SD) age of 75.6 years (7.6 years). HBMR resulted in a 41% reduction in risk for hospital admissions (Incidence rate ratio 0.59, 95% CI 0.47–0.73, P  < 0.001). The same magnitude of reduction was observed for ED visits. The mean ( SD ) cost of hospital admissions reduced from $16 957.77 ($16 118.35) before HBMR to $7488.76 ($12 773.40) after ( P  < 0.001). Among 62 patients with hospital admissions before and after HBMR , the mean ( SD ) LOS decreased from 26.5 days (22.4 days) to 17.6 days (17.8 days; P  = 0.010). The team identified 525 DRP from 1353 medications reviewed. Of these, 34 (6.7%) and 174 (34.1%) were resolved with and without physician involvement, respectively. The most common DRP identified were failure to receive drug ( n  = 163, 31.0%) and untreated indication ( n  = 140, 26.7%). Conclusions The multidisciplinary HBMR program was associated with reduced ED visits, hospital admissions, LOS and costs in older adult Singaporeans with multiple DRP . Geriatr Gerontol Int 2017; 17: 302–307.