Protocol for a randomised controlled trial evaluating the impact of a community pharmacy discharge medication reconciliation service on unplanned hospital readmissions – The DCMedsRec trial

Gregory Duncan, Cathy Ngo, Laura Fanning, David A. Taylor, Kevin McNamara, Suzanne Caliph, Bill Suen, Stefanie Johnston, Peteris Darzins

Research output: Contribution to journalArticleOtherpeer-review

Abstract

Introduction: A substantial proportion of hospital admissions and readmissions are directly attributable to preventable medication-related harm. Interventions that reduce these harms could avert significant suffering and healthcare costs. Objectives: The Discharge Medications Reconciliation (DCMedsRec) trial will evaluate a structured medication reconciliation service by community pharmacists post hospital discharge on the risk of 30-day unplanned readmission. Electronic access to the Hospital Discharge Summary via My Health Record will underpin this service. Methods: DCMedsRec is a non-blinded randomised controlled trial of an intervention by community pharmacists within 30 days of hospital discharge in Melbourne, Australia. Patients discharged from hospital will be assessed by a hospital pharmacist for trial eligibility. If eligible, patients will be randomised to either a control or intervention group by sequentially marked sealed envelopes. Intervention patients receive an invitation to the DCMedsRec service at a participating community pharmacy, who will be reimbursed. Control patients will receive usual care. A Number Needed to Treat of 20 will require 293 DCMedsRec interventions to achieve 80% power. With a predicted 30% uptake, a minimum sample of 977 in the intervention arm is required. Outcomes: The primary outcome will be the rate of 30-day unplanned hospital readmission in intervention (DCMedsRec) versus usual care groups. Secondary analyses will evaluate the economic impact of the intervention and a qualitative thematic analysis of the experience and value of the service for both patients and service providers (community pharmacists). Analysis: An intention-to-treat analysis will be used to assess intervention efficacy and results will be reported using risk ratios with 95% confidence intervals. Cost-effectiveness analysis will compare within-trial costs and outcomes of the DCMedsRec versus usual care from a health-system perspective. Trial registration and funding: This trial is registered with the Australian and New Zealand Clinical Trials Register and funded by the Australian Digital Health Agency.

Original languageEnglish
Number of pages6
JournalResearch in Social and Administrative Pharmacy
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Care transition
  • Community pharmacy
  • Digital health
  • Hospital discharge
  • Medication reconciliation
  • Medication safety

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