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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Lenaghan, Elizabeth Hand, Christopher Lipp, Alistair Christou, Maria Evans, David Harvey, Ian Holland, Richard Smith, Richard Shepstone, Lee |
| Spatial Coverage | England |
| Description | Author Affiliation: Holland R ( School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ. r.holland@uea.ac.uk); |
| Abstract | Objective To determine whether home based medication review by pharmacists affects hospital readmission rates among older people. Design Randomised controlled trial. Setting Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk. Participants 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge. Intervention Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care. Main outcome measure Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D. Results By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, -0.05 to 0.06; P = 0.84, t test). Conclusions The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review. |
| ISSN | 09598138 |
| e-ISSN | 17561833 |
| Journal | BMJ (British Medical Journal) |
| Issue Number | 7486 |
| Volume Number | 330 |
| Language | English |
| Publisher | British Medical Journal Publishing Group |
| Publisher Date | 2005-02-01 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Aftercare Drug Utilization Review Statistics & Numerical Data Emergency Treatment Utilization House Calls Patient Readmission Pharmacists Self Administration Attitude Of Health Personnel Home Care Services Patient Compliance Patient Education As Topic Pharmacies Prognosis Quality Of Life Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't Medicine |
| Content Type | Text |
| Resource Type | Article |
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