How GP pharmacist medicine reviews prevent hospital readmissions

When under the care of a general practice pharmacist, patients recently discharged from hospital are far less likely to re-present, according to new research.

PSA National President Associate Professor Chris Freeman is the lead author of a report that showed how embedding pharmacists in general practices can reduce both hospital readmissions and emergency department (ED) presentations.

‘When pharmacists work closely with GPs, high-risk groups are 31% less likely to be readmitted or re-present to hospital at 12 months, and 64% less likely at 30 days,’ said A/Prof Freeman, who is also a GP pharmacist.

‘More funding is required to support this collaborative model of care.’

REMAIN HOME was a stepped wedge, cluster randomised controlled trial that assessed patients from 14  general practices in southeast Queensland who were recently discharged from public hospitals.

Participants were split into control (177 patients) or intervention (129 patients) groups, with the latter the recipients of medicine management reviews conducted by pharmacists integrated into their general practice.

The intervention, which took place 1 week post-discharge, included:

• a patient-pharmacist consultation
• a debrief of the outcomes between the pharmacist and GP
• a patient appointment with the GP, where possible on the same day.

During the GP pharmacist consultation, a medicine review was conducted to identify any adverse effects. Patients’ discharge medicines lists were reconciled with their GP records, and any changes to their usual medicines during the hospital admission were discussed. 

Follow up consisted of an in-person or telephone appointment with the patient, and discussions with community and hospital pharmacists, as well as outside prescribers about any changes to regular medicines, or recent issues or discrepancies around their medicine use.

During the first consultation, pharmacists found a mean of four medicine-related problems, including duplication, adherence or issues related to the patient’s condition.

After 12 months, 282 hospital readmissions were recorded in the control group compared with 136 in the intervention patients. There were also significantly less (54%) ED presentations in the intervention group.

Along with harm reduction, the study revealed significant economic benefits to the pharmacist interventions.  

‘The estimated incremental net cost benefit of the intervention was $5072 per patient, with a benefit‒cost ratio of 31:1,’ the researchers stated in the report.

Medicine-related issues post-discharge

A study published in the British Journal of Pharmacology found medicine-related harm affects as many as one in three older patients (median age 82 years). 

Deborah Hawthorne MPS, a GP pharmacist based in Wangaratta, Victoria, said recently hospitalised patients have either been sick or through trauma, making it challenging to process changes or additions to their medicines.

‘No matter how good a patient’s health literacy is, the amount of information they can retain in this state is usually minimal,’ she told Australian Pharmacist.

‘Duplication is common. People often don’t realise that they’ve been changed to a different medicine within the same class that does the same job.’

Lack of adherence, accidental overuse or reintroducing medicines post-hospital stay are also common problems.

‘Some patients won’t realise that they need to continue taking medicines post-discharge, and in some instances, such as for anticoagulants prescribed after a heart attack, for life,’ Ms Hawthorne said. 

‘It can go the other way as well. Sometimes people take medicines such as proton pump inhibitors longer than they need to.’

Becoming a GP pharmacist

A/Prof Freeman, one of the first pharmacists to work in a general practice in Australia, said PSA is committed to unlocking this opportunity for pharmacists.

‘PSA’s Pharmacists in 2023 report states that, by 2023, pharmacists should be embedded within healthcare teams to improve decision making for the safe and effective use of medicines,’ he said.

To assess if you are ready to become a GP pharmacist, PSA recommends the following criteria:

• current registration as a pharmacist with the Australian Health Practitioner Regulation Agency
• minimum 2 years’ experience post-registration
• medication management review accreditation (desirable but not essential)
• complete or be enrolled in the PSA GP Pharmacist Foundation Training.

The PSA’s foundation training provides an overview of core knowledge and skills required by pharmacists who want to work in general practice, including topics such as the general practice team, the Medicare Benefits Schedule, Practice Incentives Program and health records. 

The PSA also provides a wide range of practice support tools including the Guidelines for General Practice Pharmacists, activity checklists and needs assessment for GP Pharmacists.

‘As more pharmacists are embedded in interprofessional healthcare teams, PSA will support them to advance in their chosen career paths and provide the best possible care,’ A/Prof Freeman said.