In this episode, I’ll discuss the benefits of a pharmacy-driven medication history.
The concept of specialization in medicine to achieve superior results has been prevalent for more than 100 years and is rarely subjected to scrutiny. However with a modern focus on evidence-based medicine, to change the way a long-established practice is done usually requires peer-reviewed evidence.
To a pharmacist, it makes sense that pharmacy-driven medication histories for patients admitted to the hospital would provide benefits to patients in the same way that having a cardiologist manage heart failure over a generalist would to a heart failure patient. But to change the way an established process such as taking a medication history is done and to shift hospital resources to facilitate this is difficult to do without peer-reviewed evidence of some sort.
A group of pharmacists from Boston, Massachusetts recently published their comparison of inpatients who received a pharmacy-driven medication history to those who did not in AJHP.
Over 11,000 general medical patients were analyzed in this retrospective review and approximately 1 patient received a medication history by a pharmacy-trained personnel such as a pharmacist, resident, intern, student, or technician for every 4 patients who did not.
The authors used inverse probability treatment weighting in an attempt to adjust for possible confounding errors in the data. To do this the authors assessed 52 possible covariates used logistic regression to create a propensity score for each patient, and weighted each patient based on this score to remove confounding.
The authors assessed the outcomes of length of stay (LOS), in-hospital mortality, and both 7-day and 30-day unplanned readmissions.
After adjustments, the length of stay in the pharmacy-driven medication history group was about 16 hours less compared to the group who did not have a pharmacy-driven medication history. This difference was statistically significant.
After adjustments, the in-hospital mortality rate in the pharmacy-driven medication history group was 2.34% compared to 3.72% for the group who did not have a pharmacy-driven medication history. This difference was also statistically significant with an odds ratio of 0.62.
There were no differences in the rates of 7-day and 30-day unplanned readmissions between groups.
The authors concluded:
Patients admitted to the general medicine service who had their medication history obtained by PTs during a pharmacy-driven quality improvement initiative had shorter lengths of stay and lower in-hospital mortality, but the intervention had no significant effect on all-cause 7- and 30-day readmissions. Our findings support the premise that obtaining an accurate medication history on admission is paramount to high-quality, efficient, and safe patient care.
The authors encouraged other research to be done in this area, given that their hospital is a large “quaternary care academic medical center that cares for complex medicine patients, and thus the observed results may not be generalizable to other settings.”
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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.