Do pharmacists have a role in reducing emergency admissions?

Alyson Huntley is a Research Fellow at the University of Bristol’s Centre of Academic Primary Care. She has recently published a systematic review of pharmacist-led interventions to reduce unplanned admissions for older people.EmergencyAvoidance

The expansion of the pharmacist’s role as a contributor to patient’s health has been championed over the last couple of decades.  In addition to their traditional role, pharmacists contribute to the care of people with long term conditions by carrying out medication reviews, promoting healthy lifestyles, and supporting self-care.

The older people become, the more medications they are likely to be taking (both prescribed drugs and self-medication) leading to an increased risk of adverse reactions, interaction between drugs and poor adherence.

Medication-related problems are thought to cause up to a third of all hospital admissions in older people and 11% of admissions can be specifically attributed to non-adherence.  The National Service Framework for Older People recommended annual medication reviews to reduce these problems, with pharmacists playing a key role in this.

Our recently published review in Age and Ageing aimed to examine the impact of interventions led by pharmacists on reducing emergency admissions in older people.

We included 20 randomised controlled trials (RCTs) of pharmacist-led interventions  conducted in primary or secondary care spread across Western Europe, the US and Canada. Sixteen of the trials involved the general older population and four trials were specifically targeted the older population with heart failure.

Looking at the trials involving the general older population, data from trials involving hospital pharmacists were pooled and a rate ratio (RR) of 0.91 (95% CI 0.79, 1.06) showed that there was no effect on the number of emergency admissions with inpatient intervention only or for inpatient intervention with follow up (RR 1.01 95% CI 0.89, 1.15).

Nine trials used community pharmacists where the intervention was conducted in the shop or premises of the pharmacist. When these data were pooled, there was no reduction in emergency hospital admissions (RR 1.07 95% CI 0.96, 1.20).

However, the three trials based in hospital and following discharge which assessed medication review in the older population with heart failure showed  a significant reduction in emergency hospital admissions (RR 0.75 (95% CI 0.59, 0.95)).   It is important to note, though, that one trial was at high risk of bias and, when this was taken out of the analysis, a positive but non-statistically significant effect was still seen (RR (0.81 95%CI (0.62, 1.05)). Overall, this effect must be interpreted with caution.

This systematic review provides evidence that pharmacists do not have a role in reducing emergency hospital admissions in the older population with the possible exception of patients with heart failure. However, it does did not take into account the effects these interventions may have had on other outcomes such as medication related problems, adherence, quality of life and mortality which have been evaluated previously.

Alyson’s paper can be read in full on the journal’s website.

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