Both "Pharmacy in the Future � Implementing the NHS Plan"¹, the National Service Framework (NSF) document "Medicines and Older People"² and research by our group³ recognise that better communication across the health care interface will reduce unintentional discrepancies in prescribing post-discharge and hence drug-related problems and drug-related re-admissions. Although the pharmacist's role at discharge is well established, if not standardised, there is currently little routine communication between pharmacists in secondary and primary care. There is also little routine documentation of the pharmacist's contribution to patient care during the admission and hospital stay. Therefore, the aim of this research was to develop a standardised method of documenting drug-related information, suitable for transfer across the health care interface. The effect of this drug-related information transfer was tested on defined patient outcomes: re-admissions to hospital; utilisation of primary care services; and drug-related problems.

A multi-method approach was undertaken involving a literature review, analysis of the relevant hospital protocols and guidelines, observations and interviews with the ward pharmacists. The ward pharmacists were involved at all stages of development of the documentation, to ensure the design was evidence-based and able to integrate into current practice. This was important as the ward pharmacists completed the pharmaceutical care plans as part of their regular clinical patient activities. The final study design was a randomised-controlled trial of general and emergency medicine patients with patients allocated to the trial cohort receiving a pharmaceutical care plan at discharge for hand delivery to their GP and community pharmacist. Those in the control cohort received the usual discharge care. All patients were followed-up at 30 and 60 days post-discharge by telephone interview to establish the number of GP/practice nurse and community pharmacy visit; re-admissions to hospital; and patient reported drug-related problems post-discharge.

Currently 266 patients have been recruited to the study; 148/266 (55.5%) males and 118/266 (44.4%) females. The age of these patients ranges from 18-89 years, with a mean of 65 years. These general and emergency medicine patients are mainly cardiac 1143/266 (43%, respiratory 32/266 (12%) or gastroenterology 32/266 (12%) patients. At discharge the patients are prescribed a mean of 6.44 drugs. The re-admission rate for this sample is 20% within the study period of 60 days, with no difference in the number of re-admissions in the two cohorts. However, numbers are currently too small to detect a statistically significant difference. There is however a trend towards increased time towards decreased time to both re-admission and first GP visit in the trial cohort. We will present findings at the conference, as the preliminary data on outcomes will be known by then.

References

1. Department of Health (2000) Pharmacy in the Future � Implementing the NHS Plan. The Stationary Office: London

2. Department of Health (2001) Medicines and Older People National Service Framework: Implementing medicines related aspects of the NSF for older people. The Stationary Office: London

3. Duggan, C., Bates, I., Hough, J. and Feldman, R. (1998) Reducing adverse prescribing discrepancies following hospital discharge. The Int J Pharm Pract 6, 77-82.