ABSTRACT
BACKGROUND: Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources. OBJECTIVE: To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review. METHOD: A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively. RESULTS: 235 patients were included in final analysis (nâ¯=â¯113 prospective, nâ¯=â¯122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, pâ¯=â¯0.04 and 11/38 vs 9/84, pâ¯=â¯0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, pâ¯=â¯0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, pâ¯=â¯0.04), whereas age and Charlson comorbidity were not (pâ¯=â¯0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (pâ¯=â¯0.25). CONCLUSION: Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.
