a collaborative approach to better, safer medication management
HEALTH PROFESSIONALS AND RESEARCHERS
About 250,000 hospital admissions a year in Australia are medication-related, two-thirds of which are preventable. Medication-related problems are common after hospital admissions.
Medication reviews – Home Medicines Reviews (HMRs) and Residential Medication Management Reviews (RMMRs) – are government-funded services which have been available for over 20 years to help people to get the most benefit from their medicines and reduce their chance of experiencing harm from them.
Currently, few people who might benefit from a medication review are offered one when they leave hospital.
Aim
To investigate whether an implementation model for reducing medication harm post-discharge reduces unplanned hospital readmissions. The model will involve a timely post-discharge Medication Management Review supported by the establishment of Medication Safety Hub within the participating Primary Health Networks.
Problem
Medication problems are common when patients move across the transition of care between hospital and home. Problems that cause harm can lead to readmission to hospital.
Method
The trial uses a stepped-wedge cluster randomised trial design. All centres start in the control phase and cross over to the intervention phase at different time points.
Participants
The ASPIRE trial is recruiting participants from four hospitals in New South Wales and Queensland. Patients aged 45 years and over at risk of medication harm on discharge, according to clinical assessment and screening criteria applied before discharge, and who reside in the same Primary Health Network as the hospital, will be recruited. Research pharmacists at the hospitals will assess whether potential participants meet the required criteria. Participation in the study is entirely voluntary.
Intervention
A systems-based model for implementing timely medication review services post-discharge. The model will involve coordination of the HMR/RMMR services by a Primary Health Network Medication Safety Hub and will be co-adapted to suit local systems and context.
Core elements of the model:
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a hospital-based pharmacist to identify patients likely to benefit from a post-discharge medication review;
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a PHN-based Medication Safety Hub with a Medication Safety Pharmacist to coordinate a timely medication review;
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communication channels for medication safety oversight between hospitals and primary care;
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multi-disciplinary PHN-led professional development activities on quality use of medicine topics for local healthcare practitioners;
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a communication strategy to raise awareness among local healthcare practitioners of the new role of the PHN in coordinating medication reviews and medication safety initiatives, and the importance of timely post-discharge medication reviews.
Comparison
Usual care
Outcome
The primary outcome is 90-day unplanned, all-cause readmissions.
More information about the trial
Registration
The trial is registered in the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000121662. More details on the design and outcomes of the trial are available from this site.
Funding Source
This research has been funded by the Medical Research Future Fund (MRFF) Australian Government 2020 Medical Research Future Fund Grant opportunity:
Quality, Safety and Effectiveness of Medicine Use and Medicine Intervention by
Pharmacists: MRFQI000043.
There is no commercial sponsorship or industry funding for the ASPIRE Trial.