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Freeman, Christopher R., Scott, Ian A., Hemming, Karla, Connelly, Luke B., Kirkpatrick, Carl M., Coombes, Ian, Whitty, Jennifer 
ORCID: https://orcid.org/0000-0002-5886-1933, Martin, James, Cottrell, Neil, Sturman, Nancy, Russell, Grant M., Williams, Ian, Nicholson, Caroline, Kirsa, Sue and Foot, Holly
(2021)
Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME) Study: a stepped-wedge cluster randomised controlled trial.
Medical Journal of Australia, 214 (5).
pp. 212-217.
ISSN 0025-729X
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Abstract
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).
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | continuity of patient care,general practice,pharmacy,primary care,medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 21 Oct 2020 23:56 |
| Last Modified: | 20 Apr 2023 18:35 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/77396 |
| DOI: | 10.5694/mja2.50942 |
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