Admittance into and discharge from a hospital are traumatic events for a patient. The likelihood that a patient will be discharged from the hospital on the same medications upon which they were admitted is less than 10%, with incomplete documentation of changes in medication linked to preventable readmissions. Improved discharge information and patient education are key for reducing unintentional medication changes, patient harm, and hospital readmission.
Ramsbotton et al evaluated a post-discharge medicines review (dMUR) service for older patients undertaken by community pharmacists.1 With this service, face-to-face consultations between a patient and their regular community pharmacist are designed to identify any problems or information needs patients have with medicines and offer solutions. During the 9-month study, 30 patients were referred to their regular community pharmacist, resulting in 20 dMURs conducted (67% completion rate). Twelve (60%) were completed as per study protocol (defined as dMUR completion within 4 weeks of discharge). The others were completed after 4 weeks, following one or more prompts from HR. Patients being unable to visit the pharmacy or being non-contactable were the main reasons why dMURs were not completed as per protocol. Action plans were returned for 17 of the 20 dMURs, generating 35 interventions. The most common type of intervention was provision of information to improve their understanding of why and how they were taking their medicines; the medical condition for which the medicines were being used; and/or how to avoid side effects. Assigning a monetary value to these interventions appeared to show a four-fold return on investment. This figure, however, did not factor in hospital pharmacist time costs associated with patient recruitment, referral and follow-up. After adding the MUR fee acquired, the final cost of the service was still over £70.44 per completed dMUR (conducted in the UK) and still represented a substantial cost savings. This study shows the potential for improved patient care and a positive return on investment when community pharmacists perform dMURs. However, operational barriers exist to their delivery, and there was a need to improve communication channels between health care practitioners to deliver a holistic package of care.
Pharmacy managers can find opportunities for new services across settings; ie, community pharmacists can potentially perform services for long-term care and hospital discharge patients. This study was conducted in the UK. With incentives from patient-centered medical homes and from provisions in the Affordable Care Act, this sort of thing is becoming more prevalent in the U.S. However, effective operations management, quality control, and communication are paramount.
Additional information about Operations Management and Implementing Value-Added Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.
1Ramsbottom H, Rutter P, Fitzpatrick R. Post discharge medicines review (dMUR) service for older older patients: Cost savings from community pharmacist interventions. Res Social Adm Pharm. 2018;14(2):203-206.