Impact of systematic medication review in emergency department on patients' post-discharge outcomes-A randomized controlled clinical trial

Lisbeth Damlien Nymoen, Trude Eline Flatebø, Tron Anders Moger, Erik Øie, Espen Molden, Kirsten Kilvik Viktil, Lisbeth Damlien Nymoen, Trude Eline Flatebø, Tron Anders Moger, Erik Øie, Espen Molden, Kirsten Kilvik Viktil

Abstract

Introduction: The main objective of this study was to investigate whether systematic medication review conducted by clinical pharmacists can impact clinical outcomes and post-discharge outcomes for patients admitted to the emergency department.

Method: This parallel group, non-blinded, randomized controlled trial was conducted in the emergency department, Diakonhjemmet Hospital, Oslo, Norway. The study was registered in ClinicalTrials.gov, Identifier: NCT03123640 in April 2017. From April 2017 to May 2018, patients ≥18 years were included and randomized (1:1) to intervention- or control group. The control group received standard care from emergency department physicians and nurses. In addition to standard care, the intervention group received systematic medication review including medication reconciliation conducted by pharmacists, during the emergency department stay. The primary outcome was proportion of patients with an unplanned contact with hospital within 12 months from inclusion stay discharge.

Results: In total, 807 patients were included and randomized, 1:1, to intervention or control group. After excluding 8 patients dying during hospital stay and 10 patients lacking Norwegian personal identification number, the primary analysis comprised 789 patients: 394 intervention group patients and 395 control group patients. Regarding the primary outcome, there was no significant difference in proportion of patients with an unplanned contact with hospital within 12 months after inclusion stay discharge between groups (51.0% of intervention group patients vs. 53.2% of control group patients, p = 0.546).

Conclusion: As currently designed, emergency department pharmacist-led medication review did not significantly influence clinical- or post-discharge outcomes. This study did, however pinpoint important practical implementations, which can be used to design tailored pharmacist-led interventions and workflow regarding drug-related issues in the emergency department setting.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of patients eligible…
Fig 1. Flow chart of patients eligible for inclusion in the Emergency Department (ED).
Fig 2. Study design.
Fig 2. Study design.
During emergency department (ED) stay the Intervention group (a) received standard care and pharmacist conducted systematic medication review (identifying drug-related problem), including medication reconciliation (obtaining patients’ actual drug lists). Findings from medication reconciliation and medication review were discussed with ED physician and documented in the electronical patient record. The control group (b) received standard care (by physicians and nurses).
Fig 3. Time to next unplanned contact…
Fig 3. Time to next unplanned contact with hospital (ED-visit or hospital admission).
(A) Intention-to-treat analysis of patients with follow-up data, intervention group (n = 394) vs. control group (n = 395) (B) Per-protocol analysis of patients with follow-up data, intervention group (n = 267) vs. control group (n = 395).

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