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UBC Theses and Dissertations

Evaluating the effect of pharmacist-led medication review in high-risk emergency department patients on health services utilization Kitchen, Sophie


Background One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication review on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization. Methods Data included information from 10,783 patients who were part of a prospective, multicentre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners; medical specialists; surgical specialists; and imaging and laboratory specialists. Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community-based care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization. Results ED-based pharmacist-led medication review did not result in a significant level or trend change in total outpatient health services utilization, primary care physician visits, or ED visits relative to the standard of care in the 12 months following the intervention, even when stratified by age, hospital site, and whether patients were admitted to the hospital on their index visit. Conclusion This was the first study to measure long term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community care providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate patient and physician acceptance of pharmacist recommendations and should encourage patient follow-up to community care providers following medication reviews.

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