Content area
Full Text
Pharm World Sci (2008) 30:810815 DOI 10.1007/s11096-008-9230-7
RESEARCH ARTICLE
Post-discharge medication reviews for patients with heart failure: a pilot study
Anne Ponniah Sepehr Shakib Christopher J. Doecke Merelyn Boyce Manya Angley
Received: 18 June 2007 / Accepted: 19 May 2008 / Published online: 13 June 2008 Springer Science+Business Media B.V. 2008
Abstract Background Medication misadventure is greatest at times of change such as the transition from hospital to community. Patients with heart failure are prone to medication misadventure due to polypharmacy, inappropriate medication use and frequent readmissions. Objective To identify the barriers encountered when implementing a Liaison Pharmacist facilitated post-discharge medication management service for patients with heart failure. Method A Liaison Pharmacist contacted the patients General Practitioner (GP), sent them a medication discharge summary and organised an appointment for the patient with the GP approximately 2 days post-discharge to make a Home Medicines Review (HMR) referral. The patients community pharmacist was also contacted, sent a medication discharge summary and requested to engage an accredited pharmacist to undertake the HMR. The Liaison Pharmacist arranged for the HMR report to be sent to the
outpatient department clinic to enable assessment of outcomes at the outpatient department follow-up 12 weeks post-discharge. Main outcome measure: GP HMR referral rates. Results 90 patients were offered the service. Fifty-nine patients (66%) agreed to have their GP contacted with56 GPs agreeing to order a HMR and 41 patients having an HMR post-discharge. Barriers to the implementation of a HMR post-discharge included: patient withdrawal, low GP awareness of the HMR process and conducting the HMR in a timely manner. Conclusion This study provides evidence for the feasibility of a post-discharge pharmacy service for patients with heart failure although barriers to implementation have been identied.
Keywords Australia Care transition Continuity of care Heart failure Liaison pharmacist Medication management Medication review Seamless care
Impacts of ndings on practice
A post-discharge medication review for patients with heart failure, using their GP as a conduit, is a feasible model and can improve continuity of care.
For an optimal benet, medication reviews should be conducted 710 days after discharge, when the risk of medication misadventure is the largest.
Introduction
Heart failure, a chronic debilitating disease, is an escalating public health issue and a common cause of hospitalisation and...