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Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial
Author(s) -
Freeman Christopher R,
Scott Ian A,
Hemming Karla,
Connelly Luke B,
Kirkpatrick Carl M,
Coombes Ian,
Whitty Jennifer,
Martin James,
Cottrell Neil,
Sturman Nancy,
Russell Grant M,
Williams Ian,
Nicholson Caroline,
Kirsa Sue,
Foot Holly
Publication year - 2021
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50942
Subject(s) - medicine , pharmacist , rate ratio , emergency medicine , incidence (geometry) , emergency department , cluster (spacecraft) , randomized controlled trial , exacerbation , pharmacy , pediatrics , confidence interval , family medicine , nursing , physics , computer science , optics , programming language
Objective To investigate whether integrating pharmacists into general practices reduces the number of unplanned re‐admissions of patients recently discharged from hospital. Design, setting Stepped wedge, cluster randomised trial in 14 general practices in southeast Queensland. Participants 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. Intervention 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. Major outcomes Rates of unplanned, all‐cause hospital re‐admissions and emergency department (ED) presentations 12 months after hospital discharge; incremental net difference in overall costs. Results 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. Conclusion 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. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001627448 (prospective).