1. PICO Presentation July 29, 2011 Jaclyn Wakita Pharmacy Resident University Hospital of Northern British Columbia

2. PICO P: Elderly patients (65 or older) discharged from hospital to home I: Pharmacist led Med Rec at discharge C: Standard discharge process O: Readmission rates to hospital

3. Background: Medication Reconciliation Medication Reconciliation is the process of obtaining and maintaining an accurate and detailed list of all prescribed and non prescribed drugs that a patient takes. -Institute for Health Care Improvement

4. Important Outcomes for Med Rec at Discharge Death Serious Adverse Events – Readmission to hospital – DRPs Medication Discrepancies

5. But WHY? The goal of the discharge process is to provide continuity of care ~20 % of patients discharged from hospital to home have an AE ~20-30 % of AE are due to medication errors These AE can be serious and may lead to hospitalization Question: Would pharmacist led Med Rec at discharge reduce readmission rates to hospital?

6. Literature Search MEDLINE, EMBASE, Pubmed, IPA Web of knowledge, CADTH MeSH / Keywords – Medication Reconciliation – Discharge, Patient / Patient Discharge (focus) – Pharmacist

7. Summary of Results Narrowed for Med Rec “at discharge” (then outcomes to “readmission rates”) MEDLINE: 5 studies (1) EMBASE: 2 studies, 1 commentary (1) Pubmed: 1 IPA: 3 abstracts CADTH: none (one review at admission)

8. Experimental Study Impact of a Pharmacist-Facilitated Hospital Discharge Program University of Michigan Medical Center General medicine service Objective: To assess the impact of a pharmacist- facilitated discharge program on medication discrepancies and hospital readmissions

9. Intervention vs. Control Intervention group, N=358 Control group, N=366 – Groups were found to be similar, generally Conclusion: Compared to control, the intervention did not reduce readmission rates to hospital within 30 days of discharge; however, it did decrease medication discrepancies.

10. Bottom Line Many study limitations Balance cost vs. benefit More studies need to be conducted

11. References Walker P et al. Impact of Pharmacist-Facilitated Hospital Discharge Program. Arch Intern Med 2009;169(21):2003-2010. Jha. AK. Medication Reconciliation by Pharmacists at Discharge Did Not Lead to Reduced Readmission Rates. JCOM 2010;17(1):13-14. Institute for healthcare improvement. Definition of Medication Reconciliation. Available at: www.ihi.org