Manya Angley
Research & Consulting



This project was funded by the Australian Government Department of Health and Ageing as part of the
Fourth Community Pharmacy Agreement Research and Development Program managed by the
Pharmacy Guild of Australia.

This state wide project was led by Dr Angley and conducted in 2008/2009.

The risk of medication misadventure is high in the 7 to 10 day period following transition from hospital to community. Post-discharge Home Medicines Reviews (HMRs) can be facilitated by hospital-based liaison pharmacists but timeliness of HMR conduction is problematic. In this project we trialled a post-discharge medication model that sought to enable medication reviews for 'high' risk patients to occur within 7 days post-discharge across 3  South Australian metropolitan hospitals. In addition to a HMR pathway it included a Hospital Initiated Medication Review (HIMR) pathway where hospital doctors referred patients directly to community or accredited pharmacists. The HIMR pathway was activated when general practitioners (GPs) indicated a HMR could not occur within 7 days.  Time to conduction to post-discharge medication reviews was determined for the HMR and HIMR pathways. Of the 97 consenting patients, 92 patients were deemed to be at ‘high’ risk. HIMRs were organised for 59 patients; with 52 patients completing the HIMR process. Of the 22 HMRs organised via the patient’s GP, 18 patients completed the process. The times to conduction of HIMRs and HMRs was statistically significantly different, with HIMRs and HMRs taking 6.54 ± 4.73 and 11.11 ± 7.44 days respectively (p=0.0235). This study has shown HIMRs can be facilitated in a timelier manner than post-discharge HMRs organised using existing community processes.  Conduction of reasonably timely post-discharge HMRs can occur when GPs are made aware of their urgency, patients have been identified as being at 'high' risk of medication misadventure by the hospital home team and GPs are supported by a liaison pharmacist.

Researchers: Dr Manya Angley, Ms Anne Ponniah, Ms Josephine Bong, Ms Vaishali Padhye, Ms Lisa Spurling, Dr Sepehr Shakib