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Title: Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka.
Austin Authors: Shanika, Lelwala Guruge Thushani;Jayamanne, Shaluka;Wijekoon, Chandrani Nirmala;Coombes, Judith;Perera, Dhineli ;Mohamed, Fahim;Coombes, Ian;De Silva, Hithanadura Asita;Dawson, Andrew Hamilton
Affiliation: Department of Allied Health Science, Faculty of Medical Sciences, University of Sri Jayewardenapura, Nugegoda, Sri Lanka
Faculty of Medical Sciences, University of Sri Jayewardenapura, Nugegoda, Sri Lanka
Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
School of Pharmacy, University of Queensland, Brisbane, Australia
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
Faculty of Medicine, University of Sydney, Sydney, Australia
Issue Date: 1-Mar-2018 2017-11-30
Publication information: Bulletin of the World Health Organization 2018; 96(3): 155-164
Abstract: To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.
DOI: 10.2471/BLT.17.198366
PubMed URL: 29531414
Type: Journal Article
Appears in Collections:Journal articles

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