Emergency department-based medication review on outpatient health services utilization: interrupted time series
Open accessAbstract
Background: One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization. Methods: Data included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk based on their medical history, were systematically allocated to receive either a medication review (n = 6403) or the standard of care (n = 4380). Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization. Results: ED-based pharmacist-led medication review did not result in a significant level or trend change in the primary outcome of total outpatient health services utilization. There were also no differences in the secondary outcomes of primary care physician visits or ED visits relative to the standard of care in the 12 months following the intervention. Our findings were consistent when stratified by age, hospital site, and whether patients were discharged on their index visit. Conclusion: This was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.
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The benefits of medication reviews to future health service use are unclear.
“though benefits to future health service use are unclear.50”
From Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study (2023) · cites this paper as [50]
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- Authors
- Kitchen, S. A., McGrail, K., Wickham, M. E., Law, M. R., & Hohl, C. M.
- Affiliations
- University of British Columbia (CA)
- UBC Centre for Health Services and Policy Research (CA)
- Corresponding author
- Hohl, Corinne M.
- Venue
- BMC Health Services Research
- Published
- 2020-03-26
- Volume
- 20
- Issue
- 1
- Pages
- 254-254
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC7098150
- OpenAlex
- W3013294735
- Cited by
- 17
- References
- 38
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 1
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Collections
- Funders
- Vancouver Coastal Health Research Institute (N/A)
- BC Ministry of Health (N/A)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- clinical pharmacists, adverse drug reactions, emergency department visits, physician visits, drug-related problems, pharmacist recommendations, primary care
- MeSH terms
- Adult, Aged, Aged, 80 and over, Ambulatory Care, Canada, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prospective Studies, Drug Utilization Review, Young Adult, Interrupted Time Series Analysis
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