Authors (including presenting author) :
Lau CH(1)(3), Cheng LP(2)(3), Woo HS(2), You HSJ(3)
Affiliation :
(1)Department of Pharmacy, Tseung Kwan O Hospital, (2)Department of Pharmacy, United Christian Hospital, (3)School of Pharmacy, The Chinese University of Hong Kong
Introduction :
Patients with cardiovascular diseases are prone to drug non-adherence and medication-related problems, especially at transitions of care. As ward-based pharmacist service and post-discharge follow-up have been well-studied to improve clinical outcomes in other settings, a structured pharmacist service was launched in a short-stay medical unit named Emergency Medicine Ward (EMW).
Objectives :
(1)to enhance pharmaceutical care for EMW patients admitted for cardiovascular diseases during hospitalisation and after discharge; (2)to evaluate the clinical impact of pharmacist service on unplanned 30-day readmission rates and drug adherence.
Methodology :
A single-centered, prospective, quasi-experimental design was adopted. Adult patients admitted to EMW in United Christian Hospital (UCH) for cardiovascular diseases or related symptoms with at least one medication for cardiovascular diseases at discharge were recruited in the intervention group. They received medication review, bedside counselling and two post-discharge follow-ups. They were matched with historical control patients in UCH via propensity score matching. The primary outcome was the unplanned all-cause 30-day readmission rate analysed by McNemar's test and multivariable logistic regression. The secondary outcomes were drug-related 30-day unplanned readmission rate, changes in drug adherence assessed with Adherence Scale in Chronic Diseases (ASCD) and analysis on drug-related problems and pharmacist interventions.
Result & Outcome :
142 patients were included for both intervention and usual care group for the intention-to-treat analysis. A significantly lower unplanned all-cause 30-day readmission rate was observed in the intervention group [12.7% vs 28.9%, P=0.001; OR:0.25, 95% CI:0.11-0.57, P=0.001]; Similar result was also seen in unplanned drug-related 30-day readmission rate [7.0% vs 20.4% P=0.002; OR: 0.19, 95% CI:0.07 - 0.50, P<0.001]. A significant increment was observed in the proportion of patients with high drug adherence level in ASCD after intervention (18.3% vs 53.4%, p <0.001, McNemar's test). 119 interventions were made for 123 drug-related problems identified for the intervention group. 42% of the interventions were at prescriber level, and 92% of them were accepted and fully implemented.
