One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization. Data included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk based on their medical history, were systematically allocated to receive either a medication review (n = 6403) or the standard of care (n = 4380). Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization. ED-based pharmacist-led medication review did not result in a significant level or trend change in the primary outcome of total outpatient health services utilization. There were also no differences in the secondary outcomes of primary care physician visits or ED visits relative to the standard of care in the 12 months following the intervention. Our findings were consistent when stratified by age, hospital site, and whether patients were discharged on their index visit. This was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.

中文翻译：

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基于急诊科的门诊医疗服务使用药物审查：时间序列中断

在加拿大，急诊室（ED）的拜访率为九分之一，这是由不良药物事件，用药的意外影响和有害影响引起的。临床药剂师进行的药物审查是旨​​在优化药物治疗和解决不良药物事件以影响患者预后的干预措施。然而，药物治疗对长期门诊医疗服务利用的影响尚不清楚。这项研究研究了临床药剂师进行的药物审查对长期门诊医疗服务利用的影响。数据包括来自2011年至2013年的10783名患者的信息，这是一项前瞻性，多中心质量改善评估的一部分。门诊医疗服务的利用被定义为ED的就诊总数和与医生的联系，分为四个医师专长小组：全科医生和家庭医生（GP）；医学专家；外科专家；以及影像和实验室专家。在分诊期间，根据其病史被视为高危患者，被系统地分配为接受药物复查（n = 6403）或护理标准（n = 4380）。药物审查涉及对患者药物的严格检查，以识别和解决与药物有关的问题，并将这些结果传达给社区护理提供者。中断时间序列分析比较了干预对卫生服务利用的影响和相对于干预前利用差异的护理控制标准的影响。基于ED的药剂师主导的药物复审并未导致总门诊医疗服务利用的主要结果发生显着水平或趋势变化。干预后的12个月内，初级保健医师就诊或ED就诊的次要结局相对于护理标准也没有差异。当按年龄，住院地点以及患者是否在索引就诊时进行分层时，我们的发现是一致的。这是在基于ED的药物审查后首次测量医师就诊长期趋势的研究。GP和ED访视的水平和趋势缺乏差异，表明药剂师的建议可能未充分传达给社区提供者，和/或建议可能未影响医疗保健的提供。