This appeared last week:
Joint media release - New trial to improve medicine safety for those leaving hospital
13 March 2019: A new trial service to help patients better manage their medication after they leave hospital will be launched at Box Hill tomorrow.
Poor medication management during or immediately after a hospital stay is a risk factor in 28% of potentially avoidable hospital re-admissions within 30 days.
DC MedsRec is a community pharmacy-based service for patients discharged from Box Hill Hospital with four or more medicines, designed to help reduce the risk of harm from dangerous drug interactions.
Eligible patients will meet with a trained community pharmacist, who will look at their hospital discharge summary via My Health Record, along with a range of other medication information.
The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from hospital are followed up.
The pharmacist also will also offer to dispose of any discontinued medications and prescriptions for the patient, with their consent.
The service is an Australian Digital Health Agency (ADHA) pilot project, managed by Eastern Health in partnership with Monash University.
“Community pharmacies from the Eastern Health area will take part in the pilot, with up to 5,000 patients potentially involved,” said Eastern Health Chief Executive Adjunct Professor David Plunkett.
The success of the service will be evaluated after 12 months. The results could potentially shape future projects to help patients throughout Australia better manage their medicines.
“We know medication errors often occur when patients leave hospital and can mean patients end up being readmitted — so we will assess the impact of this new service on 30-day unplanned readmission rates to hospital,” said project lead Greg Duncan, from Monash University.
Australian Digital Health Agency’s CEO Tim Kelsey said the service was part of a $8.5 million program trialling innovative new approaches in post-hospital support, palliative care and the management of chronic health conditions, using digital technology to support better health outcomes.
“Pharmacists involved in the Box Hill project will be able to access their patients’ hospital discharge summaries quickly and easily using My Health Record,” he said.
“The ultimate aim is to ensure patients with complicated medication regimens don’t end up back in hospital after taking a bad combination of medicines.”
ENDS
Media contact
Australian Digital Health Agency Media Team
Mobile: 0428 772 421 Email: media@digitalhealth.gov.au
Australian Digital Health Agency Media Team
Mobile: 0428 772 421 Email: media@digitalhealth.gov.au
About the Australian Digital Health Agency
The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure: evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information: www.digitalhealth.gov.au.
About Eastern Health and Monash University
Eastern Health’s catchment is one of the geographically largest in the state, with services to over 1 million people. Services are delivered from 65 sites across 21locations including Box Hill, Maroondah and Angliss hospitals and well as numerous community care centres. Box Hill Hospital (Eastern Health) was the first ranked hospital in Australia being the second ranked Australian research organisation and 36th research organisation overall in the world by Times Higher Education in 2018.
Eastern Health’s catchment is one of the geographically largest in the state, with services to over 1 million people. Services are delivered from 65 sites across 21locations including Box Hill, Maroondah and Angliss hospitals and well as numerous community care centres. Box Hill Hospital (Eastern Health) was the first ranked hospital in Australia being the second ranked Australian research organisation and 36th research organisation overall in the world by Times Higher Education in 2018.
Here is the link to the release:
There is also press coverage here:
New post-discharge pilot
A new trial service to help patients better manage their medication after they leave hospital will be launched in Melbourne on Thursday
Poor medication management during or immediately after a hospital stay is a risk factor in 28% of potentially avoidable hospital re-admissions within 30 days, says the Australian Digital Health Agency.
The new service, DC MedsRec, is a community pharmacy-based initiative for patients discharged from Melbourne’s Box Hill Hospital with four or more medicines, and has been designed to help reduce the risk of harm from dangerous drug interactions.
Eligible patients will meet with a trained community pharmacist, who will look at their hospital discharge summary via My Health Record, along with a range of other medication information.
The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from hospital are followed up.
The pharmacist also will also offer to dispose of any discontinued medications and prescriptions for the patient, with their consent.
More here:
Think about this for a moment. A patient is discharged from the hospital and the final medications are decided upon the then dispensed by the hospital pharmacist. The hospital system is the source of truth on the discharge medications.
At some time in the future a discharge summary will be created. Given Box Hill Hospital runs Cerner it would seem more sensible to use remote access to the Cerner system directly rather than hope the DS has been finalised and uploaded.
Of course when all you have is the myHR you need to think of something it might be useful for. The value of this trial will largely be from having a medication review soon after discharge, if that is what happens, rather than any trivial added value from using the myHR.
This trial is assessing the value of pharmacist medication review not the myHR!
This view is confirmed by a very recent study from the US.
January 25, 2019
Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions With Connection to Primary Care Within 7 Days of Hospital Discharge
Author Affiliations Article Information
Question Is connection to primary care within 7 days of hospital discharge associated with reduced readmissions?
Findings In this cohort study of 1531 hospital discharges among adult Medicaid patients in Camden, New Jersey, patients attending a primary care follow-up appointment as part of the 7-Day Pledge program had fewer 30- and 90-day readmissions compared with patients with less timely primary care follow-up or none.
Meaning The findings suggest that facilitated connection of patients to primary care within 7 days of hospital discharge is associated with fewer hospital readmissions.
Abstract
Importance Previous research suggests the important role of timely primary care follow-up in reducing hospital readmissions, although effectiveness varies by program design and patients’ readmission risk level.
Objective To evaluate the outcomes of the 7-Day Pledge program to reduce readmissions by increasing access to timely primary care appointments after hospitalization.
Design, Setting, and Participants Retrospective cohort study of hospital readmissions among Medicaid patients 18 years or older hospitalized from January 1, 2014, to April 30, 2016, in Camden, New Jersey. To assess each patient’s hospital use before and after hospital discharge, all-payer claims data from 4 health care systems were linked to insurers’ lists of patients assigned to Camden-based primary care practices. A total of 1531 records were categorized by timing of a primary care appointment after discharge. Discharges followed by a primary care appointment within 7 days (treatment group) were matched by propensity scores to those with less timely or no primary care follow-up (nontreatment pool).
Interventions Targeted patient enrollment during hospital admission, primary care practice engagement, patient incentives to overcome barriers to keeping an appointment, and reimbursements to practices for prioritizing patients recently discharged from the hospital.
Main Outcomes and Measures The primary outcome was the number of hospital discharges followed by a readmission within 30 days. The secondary outcome was the number of hospital discharges followed by a readmission within 90 days.
Results There were 2580 hospitalizations of patients 18 years and older included on the patient lists from January 1, 2014, to April 30, 2016. Of these, 1531 records categorized by timing of a primary care appointment after discharge were studied. The treatment group consisted of 450 discharged patients (mean [SD] age, 48.7 [14.7] years; 289 [64.2%] female; 203 [45.1%] black, non-Hispanic). The nontreatment pool consisted of 1081 discharged patients (mean [SD] age, 48.1 [14.9] years; 599 [55.4%] female; 526 [48.7%] black, non-Hispanic). Among this cohort, the number of discharges followed by any readmission was lower for patients with a primary care visit within 7 days of hospital discharge than for their matched referents at 30 days (57 of 450 [12.7%] vs 78.8 of 450 [17.5%]; P = .03) and 90 days (126 of 450 [28.0%] vs 174 of 450 [38.7%]; P = .002) after discharge.
Conclusions and Relevance Facilitated receipt of primary care follow-up within 7 days of hospital discharge was associated with fewer Medicaid readmissions. The findings illuminate the importance of reducing barriers that patients and providers face during care transitions.
Here is the link (full text is free):
Basically follow-up after discharge helps mostly – not the myHR!
David.
If you look at the project description on the Monash Uni site:
ReplyDeletehttps://research.monash.edu/en/projects/dcmedsrec-reducing-hospital-readmission-by-enhanced-my-health-rec
It says the project effective start/end dates are 16/07/18 → 30/06/19
So they launched the project 9 months after it started and with 3 months left.
The media release from ADHA dated 13 March
https://www.digitalhealth.gov.au/news-and-events/news/joint-media-release-new-trial-to-improve-medicine-safety-for-those-leaving-hospital
says:
"The success of the service will be evaluated after 12 months."
Something doesn't add up.
Neither does this "trial" seem to fit in with ADHA's Framework for Action. I can't find any mention of it, although it could be hidden in the test bed projects.
https://conversation.digitalhealth.gov.au/framework-for-action
Considering the Uni project description says it started in June 2018 and the Framework document is dated July 2018, once again something doesn't add up.
Surely even the board must realise they are being bullshitted to
ReplyDelete@ 6:34 PM No way. When a sociopath weaves the web with 'con'fidence everyone believes what is said. The Board is as gullible as everyone else..
ReplyDelete