ABSTRACT

Evaluation of post-discharge pharmacist-only review in a General Medicine ambulatory care setting

Eleanor van Dyk¹, Michael Dooley¹, Erica Tong¹, Susan Poole¹, Gary Yip²
1. Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia;
2. General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia

Aims: To evaluate whether a novel advanced pharmacist practice role in a general medicine post-discharge clinic is feasible, effective and safe.

Methods: A retrospective cohort study was conducted between April and September 2016 within the General Medicine Unit (GMU) at Alfred Health, Melbourne, Australia. Patients referred for review in the GMU post-discharge clinic were included. Reviews were undertaken via telephone or face-to-face appointment, with a pharmacist-only, a doctor-only or pharmacist plus doctor, according to each patient’s medical needs. Patients reviewed by a pharmacist-only could be escalated to a medical review if required, as determined by the pharmacist. Extensive data, including pharmacist activity and frequency of escalation, were collected.

Results: 861 patients were referred for post-discharge review, 123 (14.3%) for pharmacist-only review and 738 (85.7%) for doctor-only or partnered review. Excluding FTAs, 89 of 586 patients (15.2%) underwent independent pharmacist review.  Of the 89 patients, 85 (95.5%, 95% CI 91.2-99.8%) were reviewed without unplanned escalation to a doctor. Four patients (4.5%, 95% CI 0.2-8.8%) required escalation, three due to unanticipated clinical symptoms and one for a medication-related problem. A greater proportion of patients required escalation in the face-to-face group, compared with the telephone group (p=0.003). There was no difference in 30-day readmission rates between the groups (9% for pharmacist-only group versus 8.2% for all other patients, p=0.84).

 

Conclusion: Pharmacist-only post-discharge review of GMU patients is feasible, effective and safe. In this novel service model, pharmacists reviewed 15% of all patients, and only a minority (4.5%) of these patients required escalation to an unplanned medical review. Thirty-day readmission rates did not differ between the groups. This study provides the first evidence that pharmacists working in a GMU outpatient service could potentially improve workforce distribution and quality of clinical care in a subset of patients.