title: Effectiveness of a multidisciplinary home-based medication review program in reducing healthcare utilization among older adult Singaporeans.
abstract: OBJECTIVE
  The study aimed to: (i) evaluate the effectiveness of a multidisciplinary home-based medication review (HBMR) program in reducing hospital admissions and emergency department (ED) visits, cost of hospital admissions and length of stay (LOS); and (ii) determine the prevalence of drug-related problems (DRP) in elderly Singaporeans.
  
  
  METHODS
  A retrospective observational study was carried out at an academic medical center in Singapore. Patients referred between 1 March 2011 and 31 December 2012 were included. Frequency of hospital admissions and ED visits, cost of hospital admissions, and LOS 6 months before and after HBMR, number of DRP, their categories, and their outcomes (i.e. resolved/ unresolved) were recorded.
  
  
  RESULTS
  The analysis included 107 patients with a mean (SD) age of 75.6 years (7.6 years). HBMR resulted in a 41% reduction in risk for hospital admissions (Incidence rate ratio 0.59, 95% CI 0.47-0.73, P < 0.001). The same magnitude of reduction was observed for ED visits. The mean (SD) cost of hospital admissions reduced from $16 957.77 ($16 118.35) before HBMR to $7488.76 ($12 773.40) after (P < 0.001). Among 62 patients with hospital admissions before and after HBMR, the mean (SD) LOS decreased from 26.5 days (22.4 days) to 17.6 days (17.8 days; P = 0.010). The team identified 525 DRP from 1353 medications reviewed. Of these, 34 (6.7%) and 174 (34.1%) were resolved with and without physician involvement, respectively. The most common DRP identified were failure to receive drug (n = 163, 31.0%) and untreated indication (n = 140, 26.7%).
  
  
  CONCLUSIONS
  The multidisciplinary HBMR program was associated with reduced ED visits, hospital admissions, LOS and costs in older adult Singaporeans with multiple DRP. Geriatr Gerontol Int 2017; 17: 302-307.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Kheng Yong
authors.initials: KY
authors.lastname: Ong
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Mcvin Hua Heng
authors.initials: MH
authors.lastname: Cheen
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Joanne Swee Gek
authors.initials: JS
authors.lastname: Chng
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Li Li
authors.initials: LL
authors.lastname: Chen
authors.affiliation: Ang Mo Kio-Thye Hua Kwan Hospital, Singapore, Singapore.
authors.forename: Sock Mui
authors.initials: SM
authors.lastname: Ng
authors.affiliation: National University of Singapore, Singapore, Singapore.
authors.forename: Seng Han
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Paik Shia
authors.initials: PS
authors.lastname: Lim
authors.affiliation: Alexandra Hospital (Jurong Health Services), Singapore, Singapore.
authors.forename: Wei Terk
authors.initials: WT
authors.lastname: Chang
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care; D015397:Program Evaluation; D012189:Retrospective Studies; D012846:Singapore
keywords: drug-related problems; elderly; healthcare utilization; home medication review