A systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge

BACKGROUND Pharmacists’ completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload. DESIGN Systematic literature review and meta-analysis of extracted data. METHODS Medline, CINHAL, EMBASE, AMED, ERIC, SCOPUS, NHS evidence and the Cochrane databases were searched using a combination of Medical Subject Heading (MeSH) terms and free text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using CASP. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively. RESULTS Fourteen studies were included comprising five RCTs, six cohort studies and three pre-post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload. CONCLUSIONS Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload

The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease

Objective To determine whether aspirin and antioxidant therapy, combined or alone, are more effective than placebo in reducing the development of cardiovascular events in patients with diabetes mellitus and asymptomatic peripheral arterial disease

Quality Improvement in Primary Care: What to do and how to do it

Ensuring patients receive care that is safe and of high quality is an essential part of modern healthcare. To help with this, there are growing numbers of evidence-based Quality Improvement (QI) methods that can help practitioners to assess and improve the care they provide. However, for many, the experience of QI has often been felt to be “audit for audits sake” or a huge amount of work in an ever-increasing workload. To make things easier, this resource describes several QI methods that will be useful for all members of the primary care team, including GP specialty trainees, who wish to better understand and apply QI thinking and tools more effectively. It will also be helpful in supporting the wider goals of GP Quality Clusters in Scotland and the Scottish Patient Safety Programme. Similarly, application of these methods also provides important evidence of QI activity within medical appraisal, specialty training and continuing professional development more generally for clinicians and managers alike

Persistence, adherence and outcomes with antiplatelet regimens following cerebral infarction in the Tayside Stroke Cohort

&lt;i&gt;Background:&lt;/i&gt; Co-prescribed aspirin and dipyridamole are more effective than aspirin alone following cerebral infarction; however, patients may struggle with this more complex regimen. The objectives of this study were: (1) to describe postdischarge prescribing of antiplatelet regimens, (2) to measure patient persistence with different antiplatelet regimens, and (3) to measure whether persistence impacts on outcomes. &lt;i&gt;Methods:&lt;/i&gt; We used record linkage of the Tayside Stroke Cohort with community dispensed prescribing data from 1994 to 2005. All patients had suffered a radiologically confirmed cerebral infarction and were excluded if they had previously used or had other indications for antiplatelet agents. We measured persistence to initial and any antiplatelet regimen using survival analysis. To assess the impact of therapy we used survival analysis to follow up until the APTC endpoint of serious vascular event (myocardial infarction, stroke or vascular death) or censored. Antiplatelet regimen was entered as a time-dependent covariate in a Cox model that also adjusted for age, sex, history of diabetes and baseline use of nitrates and statins. &lt;i&gt;Results:&lt;/i&gt; The study cohort contained 1,407 stroke patients (mean age 70.3 years, 46.8% male), with a total follow-up of 4,243 patient-years. Patients initiated on aspirin with dipyridamole had a worse persistence to their initial regimen compared with those initiated on aspirin alone (hazard ratio for non-persistence 1.62; 95% CI 1.37–1.92), but better persistence with any antiplatelet medication long term (hazard ratio 0.86; 95% CI 0.73–1.02). Compared to aspirin monotherapy, receiving no antiplatelet therapy was associated with significantly worse patient outcomes (hazard ratio 1.50; 95% CI 1.21–1.87), whilst receiving prescribed aspirin with dipyridamole was associated with better outcomes (hazard ratio 0.75; 95% CI 0.56–0.99). Only a few patients received clopidogrel or other antiplatelet regimens. &lt;i&gt;Conclusions:&lt;/i&gt; Patients discharged on dual therapy have worse adherence to their initial regimen but better persistence to any antiplatelet agents in the long term. Continued exposure to antiplatelet regimens predicts good outcomes in patients with cerebral infarction.</jats:p