Evaluation of pharmacist-provided medication therapy management service on reducing unplanned readmissions in adult patients in Singapore
European Statement
Patient Safety and Quality Assurance
Author(s)
Elena Lee, Yue Feng Toh, Nathaniel Lim
Why was it done?
Older patients on polypharmacy are predisposed to drug related problems (DRPs). While MTM service with pharmacist involvement can reduce DRP occurrence, few have examined its impact on reducing unplanned readmissions.
What was done?
This study was designed to determine whether a pharmacist-provided medication therapy management (MTM) service can reduce unplanned readmissions through the comparison with patients receiving usual care.
How was it done?
A retrospective cohort study was conducted in Changi General Hospital. Patients present for MTM service from Jan 2016 to Dec 2019 were included in the intervention arm (n=96) while patients who attended specialist outpatient clinics were recruited as control (n=98). Index visits from the same patient within 6 months of an earlier visit were excluded. Primary outcome was the change of unplanned admission post and pre 6-month of index visit comparing intervention arm against control arm. Secondary outcomes were descriptive of DRPs identified, number of recommendations from pharmacists, types of interventions and the potential risks avoided. Primary outcome analysis was conducted with linear regression and adjusted for potential confounders.
What has been achieved?
MTM sessions resulted in the reduction of unplanned admission rate by 0.83 (95% CI: -1.31, -0.34), p=0.001, after adjusting for confounders. For patients with admission prior to the index visit, the intervention arm had statistically significant lower incidence of unplanned admission post and pre 6-month of index visit by 0.916 as compared to control group (p=0.018). There are higher number of DRPs (144 vs 2) and pharmacist recommendations (40 vs 2) were found in the intervention arm compared to control arm respectively. The most prevalent types of DRPs were ‘Non-adherence’ (80.6%), ‘Drug omission’ (5.6%), and ‘Inappropriate dose’ (2.8%). The most common potential risks avoided were increased cardiovascular risk, n=29 (22.1%), increased fall risk, n=18 (13.7%) and increased risk of fractures, n=17 (13.0%).
What next?
The study suggests that pharmacist-provided MTM service decreased unplanned readmission rate. It has improved medication safety and quality of care by identifying and resolving more DRPs.