HPE HPE 85 – Spring 2017 - Page 30

Pharmacy practice Monday to Friday with normal office hours, only providing cover to address supply problems outside of these times. Patients admitted between Friday evening and Sunday lunchtime have traditionally been unlikely to receive MR within the required timeframe. The introduction of the target therefore requires additional resources or their reallocation and therefore loss from another element of service delivery. 28 MR effectiveness A systematic review of medicines reconciliation practices by Mueller et al in 2012 18 found only a limited number of good quality studies at the time. They however all showed that the process reduced medicines discrepancies and most demonstrated a reduction in potential adverse drug events. The evidence at that time to support a reduction in post-discharge hospital utilisation was however at that time limited. The study reported variations in the model of MR delivery within different studies, which reported using pharmacists, trainee pharmacists or pharmacy technicians. The researchers, however, suggested that those services, which were limited to older people, delivered on admission, during and at discharge with direct communication with physicians and a follow up telephone call were likely to be most effective. Conversely, those studies, which showed limited effect, used pharmacists only during admission or discharge. The time of service delivery in relation to admission was not stated. A more recent systematic review of pharmacist led MR services by Mekonnen et al in 2016 2 showed that such services provided significant reductions in adverse drug event related readmissions, emergency department visits and hospital readmissions. The majority of evidence however emanated from the USA with only a small number from European and other countries (Sweden (n=3), Ireland (n=2) and Australia (n=1)). They were mainly either non-randomised controlled trials or before and after studies and consisted of interventions purely on admission, on discharge or at both points. Whilst the authors did not differentiate between single and multiple transition interventions, re-analysis of the same data showed that multiple transition interventions still had a significant effect. 22 A large number of the trials included hospitalpharmacyeurope.com within the review 2 consisted of additional elements to the intervention such as medication review, patient education, discharge plan and follow up telephone call. Medication reviews themselves performed by hospital pharmacists, are believed to reduce hospital readmissions 17 and therefore the inclusion of trials makes it difficult to determine the exact cause of the effect. The majority of studies included within the Mekonnen review 2 were focussed on high risk patients, that is, those prescribed a large number of medicines, prescribed medicines which are deemed to be high risk or have are unlikely to provide an accurate reflection of the effectiveness of the intervention. 26 As a model that is not underpinned by a randomised controlled trial, in accepting the finding, the reader has to accept that the assumptions underpinning the model would translate into their health system and that the costs realised would be the same in their country. With the significant differences seen between the organisation of USA and European health systems, it is perhaps not appropriate to directly translate these findings. The time taken for the provision of MR at both admission [\\H\¸'HRݙ\Y[X[Y[][ۈ܂]Y[YZ]Y][XZ]HTHH\XX\\ܛH]Y[KX\Y ]\XH Z\\]Z\[Y[[HYYYH[]Y['Bۙ][ۜ܈XYX]H۝[X[Y[Y[\YH\[[ۂYYX[\܈^[\KX\Z[\K\X\\]HYZ[\\][Hۂ]][\XX\[]Y[\X\܈]Y[]X\Z[\H\BZ[HYXHHZ[Zق[[YXYZ\[ۋ ۜ\]Y[KYHH[Z]Y]X[]HوH]KH\X][ۜ[\XH[[[H\ۈ\Z[\\و]Y[ H]]ܜ]H]B\[HZ\]Y][BY]Y]YH]][ۋT YYX][\’[\\[K[HHRݙ\Y[X[]\]T][ \܂[][YZ\[ۜHH][\XX\\\]Z\Y \H\™]Y[HY\]H[\[[ۂ\H YYX]H\Hو\\\ˈ [HRHݙ\Y[[ۛBX[Y[[\[[ۜ\HB]Z[Y[وۙHY][ۘ[YX\ق\X]X[]HوYH\[̌ [ܙX\[0 [\Z[\[\[\ˈ HH[[Z[[ \[X]HHZ[H BYX][\و][[YYX][ۂ\܈]][YZ\[ۈ\[TY\Y]H\XX\ X\Y[\[[ۈ\Z[HH YYX]KH[[\]\\Y[HۂTH\܈]H[XYH\[\[ۜ˜ۘ\[H]\]Hو\ܜœ][Y[Z\ۜ\]Y[\X HZ[]\ۈ]\YH[\YܙBXY][\[ \܈[][YZ\[ۜ\\[HYۚYX[[[[و\\\ˈ HX[H\ܝYX\X[]HYH\H]Y[\B[Z\YZ]\T][][ۈ[܈\X[\H]X^H܂X^H]H[YYT[]\X[Tۈ]\YH MHZ[]\\]Y[[\\\Z[HYXBYYX[H\ܙ\[Y\ˈ H MHZ[]\œ\]Y[[H\X[\Hܛ\\Z[BHYHH[X[܈[]Y[˜HY[][Z]Y܈Y][ۘ[\\\ݚYYYY]\˂HY\[H]Y[BYX][\Y[][\X\YY\˜[]Y[[X[]H\Y[][\H\ܝY H][HX[ B[\[[ۈ\[]\Y \›ݙ[ [\H\\]Y[HܙX]\^KZ[H[ZZ\[™[[ۜ]HH]]HYX \YXX^H\H][YK[Y\[X][ۙ\[]\][YH[[[و\\\\Y[]\B[\[[ۈ\HYXY \\[ۂ]\X\]HRݙ\Y[X[Y[][ۈ܈]Y[YZ]Yš][XZ]HTHH\XX\\ܛH]Y[KX\Y]\XH Z\\]Z\[Y[[HYYYH[]Y[ˈH]B\ܝHݚ\[ۈوT[Y \\œ]Y[[Y\]T]