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Original research
Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study
  1. Lauren Lapointe-Shaw1,2,3,4,
  2. Chaim M Bell2,3,4,5,
  3. Peter C Austin3,4,
  4. Lusine Abrahamyan3,6,
  5. Noah M Ivers3,7,8,
  6. Ping Li4,
  7. Petros Pechlivanoglou3,9,
  8. Donald A Redelmeier2,3,4,10,
  9. Lisa Dolovich11
  1. 1 Medicine, University Health Network, Toronto, Ontario, Canada
  2. 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4 ICES, Toronto, Ontario, Canada
  5. 5 Medicine, Sinai Health System, Toronto, Ontario, Canada
  6. 6 Institute of Health Policy, Management and Evaluation and Toronto General Research Institute, University of Toronto, Toronto, Ontario, Canada
  7. 7 Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
  8. 8 Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9 Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  10. 10 Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  11. 11 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Lauren Lapointe-Shaw, Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; lauren.lapointe.shaw{at}mail.utoronto.ca

Abstract

Background In-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.

Objective To determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.

Design Propensity score-matched cohort study.

Setting Ontario, Canada

Participants Patients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.

Exposure MedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.

Main outcome The primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.

Results MedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93–0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).

Conclusions and relevance Among older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.

  • medication reconciliation
  • transitions in care
  • medication safety

https://doi.org/10.1136/bmjqs-2019-009545

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    Footnotes

    • Twitter @LapointeShaw

    • Correction notice This article has been corrected since it published Online First.

    • Contributors Study contributors: All authors had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study guarantor: LL-S. Study concept and design: all authors. Analysis and interpretation of data: LL-S, PL. Drafting of the manuscript: LL-S. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: LL-S, PL. Obtained funding: CMB, LD. Study supervision: LD.

    • Funding This study was funded by Open Pharmacy Evidence Network, Canadian Patient Safety Institute, Ontario Ministry of Health and Long-Term Care, Canadian Institutes of Health Research. This work was also supported by ICES, which is funded by annual grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources.

    • Competing interests LL-S reports support from a CIHR Fellowship Award (FRN 146714), and the Philipson Scholar program at the University of Toronto. PCA is supported by a Mid-Career Investigator award from the Heart and Stroke Foundation. NMI reports support from CIHR and the Ontario Ministry of Health and Long-Term Care. DAR reports support from a Canada Research Chair in Medical Decision Science. CMB reports support from the Department of Medicine at the University of Toronto and Sinai Health System. None of these organisations had any involvement in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Immigration, Refugees and Citizenship Canada (IRCC). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of ICES, MOHLTC, CIHI or the IRCC. No endorsement by ICES, MOHLTC, CIHI or the IRCC is intended or should be inferred. The named organisations and funding bodies had no involvement in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.