A number of schemes have been described regarding hospital discharge planning for elderly patients. The assessment of such services focuses on potential benefits in patient knowledge/compliance and better communications between the secondary and primary care setting. This project examines the potential clinical benefits from a discharge planning scheme and subsequent follow up offering pharmaceutical care through domiciliary visits. The presentation will discuss the methodology used to assess the clinical outcomes of the project and present an analysis of some of the data that has recently been collected.

Method

Patients were recruited from both the Elderly Care and general wards at St. Thomas' Hospital, London. All elderly patients who were discharged on more than one medication and returning to their own homes were considered for inclusion. Those who relied completely on a carer to administer medicines or had sever cognitive impairment were excluded. For those who agreed to take part in the study, understanding of the prescribed discharge medication was then assessed using a standard questionnaire. Patient receiving the discharge services (intervention group) were given structured medication education supplemented by a written aid before discharging from the hospital. Where this was relevant carers were also invited to attend the education sessions. A control group received the usual discharging procedure in the hospital.

For the intervention group only, the General Practitioner and community pharmacists responsible for that patient were informed specifically of any changes in patient medication prior to admission. They were also sent any information that may be useful for patient follow-up, as well as being sent a copy of the discharge letter. After two weeks both groups received a domiciliary visit and were assessed for their medication knowledge and adherence, incidence of medication related problems, quality of life and satisfaction with the information they received before discharge. The intervention group only received further patient education and any pharmaceutical care issues identified and resolved. The domiciliary visit was repeated after six weeks. The rate and the reason for hospital readmission for all recruited patients were noted for the six-month period from the date of discharge.

Results

The study has entered its final stage of patient data collection and a target of 120 will be achieved by January 2003. Both groups will be compared for outcomes at two weeks and six weeks following discharge. A particular focus on the analysis will be clinical outcomes in terms of medication related problems, interface and pharmaceutical care issues. It is hoped to be able to quantify the impact of a service that involves follow up of discharged elderly patients by a hospital-based pharmacist.