Post-discharge medication reviews for patients with heart failure: a pilot study.
BACKGROUND
Medication misadventure is greatest at times of change such as the transition from hospital to community. Patients with heart failure are prone to medication misadventure due to polypharmacy, inappropriate medication use and frequent readmissions.


OBJECTIVE
To identify the barriers encountered when implementing a Liaison Pharmacist facilitated post-discharge medication management service for patients with heart failure.


METHODS
A Liaison Pharmacist contacted the patient's General Practitioner (GP), sent them a medication discharge summary and organised an appointment for the patient with the GP approximately 2 days post-discharge to make a Home Medicines Review (HMR) referral. The patient's community pharmacist was also contacted, sent a medication discharge summary and requested to engage an accredited pharmacist to undertake the HMR. The Liaison Pharmacist arranged for the HMR report to be sent to the outpatient department clinic to enable assessment of outcomes at the outpatient department follow-up 12 weeks post-discharge.


METHODS
GP HMR referral rates.


RESULTS
90 patients were offered the service. Fifty-nine patients (66%) agreed to have their GP contacted with 56 GPs agreeing to order a HMR and 41 patients having an HMR post-discharge. Barriers to the implementation of a HMR post-discharge included: patient withdrawal, low GP awareness of the HMR process and conducting the HMR in a timely manner.


CONCLUSIONS
This study provides evidence for the feasibility of a post-discharge pharmacy service for patients with heart failure although barriers to implementation have been identified.
Ponniah
Anne
A
University of South Australia, Adelaide, Australia.
Shakib
Sepehr
S
Doecke
Christopher J
CJ
Boyce
Merelyn
M
Angley
Manya
M
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D010351:Patient Discharge; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010821:Physicians, Family; D010865:Pilot Projects; D019338:Polypharmacy; D024382:Professional Role; D013997:Time Factors
D004364:Pharmaceutical Preparations