3767 Results of a randomised controlled study to reduce medication-related harm in older adults after hospital discharge

Abstract Introduction Medication-related harm (MRH) is a challenge for older adults in the period following hospital discharge. NHS Discharge Medicines Service (DMS), within the Community Pharmacy Contractual Framework, aims to reduce post-discharge MRH through improved communication between hospital, community pharmacists, and patients. The aim of the study was to investigate the effectiveness of an individualised medicine management plan (MMP) plus DMS in reducing medication-related harm compared to DMS only. Method Older adults ≥65 years were recruited from 8 hospitals in England and randomised to intervention (MMP of patient education about medicines and discussion around medication risk plus DMS) or control (DMS only). Baseline data included patients’ clinical and social demographics and medication risk calculated using a risk-prediction tool at the point of discharge. At 8-weeks post-discharge, trained study pharmacists or doctors verified MRH via triangulation of outcome data obtained from telephone interview with study participants and/or carers, review of GP records and identifying cause of readmission if it occurred. A process evaluation assessed the acceptability of study methods by hospital pharmacists. Results A total of 274 patients were included (140 control, 134 intervention), mean age of 80.1 years (range 65–100), 151 (55.1%) females. In both study arms, MRH was strongly associated with hospital readmission (OR = 5.29, 95% CI: 1.57–17.77) and use of A&E services (OR = 4.21, 95% CI: 1.33–13.31). Although not statistically significant, there was a consistent trend towards reduced odds of adverse outcomes in the intervention group, OR = 0.52 (95% CI: 0.16–1.68). The process evaluation showed that the study strengths were a standardised medicine management plan, objectively assessing medications risk, and identifying opportunities for pharmacist-led interventions. Conclusion MRH after leaving hospital has a substantial impact on healthcare utilisation. The study intervention has the potential to deliver clinically important benefits through reducing MRH.