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  3. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial
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Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38338.674583.AE (Published 03 February 2005) Cite this as: BMJ 2005;330:293
  1. Richard Holland, senior lecturer in public health medicine (r.holland{at}uea.ac.uk)1,
  2. Elizabeth Lenaghan, senior research associate1,
  3. Ian Harvey, professor of epidemiology and public health1,
  4. Richard Smith, reader in health economics1,
  5. Lee Shepstone, reader in medical statistics1,
  6. Alistair Lipp, director of public health2,
  7. Maria Christou, education pharmacist3,
  8. David Evans, specialist adviser, pharmaceutical services4,
  9. Christopher Hand, honorary senior lecturer1
  1. 1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ,
  2. 2 Great Yarmouth Teaching Primary Care Trust, Astley Cooper House, Estcourt Road, Great Yarmouth, Norfolk NR14 8AB,
  3. 3 Academic Pharmacy Practice Unit, University of East Anglia, Norwich NR4 7TJ,
  4. 4 Suffolk Public Health Network, Suffolk House, St Clement's, Foxhall Road, Ipswich IP3 8LS
  1. Correspondence to: R Holland
  • Accepted 2 December 2004

Abstract

Objective To determine whether home based medication review by pharmacists affects hospital readmission rates among older people.

Design Randomised controlled trial.

Setting Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk.

Participants 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge.

Intervention Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care.

Main outcome measure Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D.

Results By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, -0.05 to 0.06; P = 0.84, t test).

Conclusions The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review.

Footnotes

  • Contributors RH, IH, AL, LS, RS, MC, DE, and CH designed the study. RH, EL, LS, and RS analysed the results; all authors interpreted the results, contributed to writing revisions, and approved the final manuscript. RH is the guarantor.

  • Funding Research costs were funded by a project grant from NHS Eastern Region R&D and the Academic Pharmacy Practice Unit of the University of East Anglia. RH was funded by the MRC as a research fellow during this study. Excess treatment costs were funded by Norfolk Health Authority, Norfolk Social Services, and Suffolk Social Services.

  • Conflict of interest AL works for a primary care trust, an organisation that pays for healthcare services and would be interested in an intervention that has been shown to reduce unnecessary readmissions to hospital. The trust's predecessor, Norfolk Health Authority, contributed some funding towards this study

  • Ethical approval The protocol for this study received ethical approval from Norwich District, King's Lynn, Great Yarmouth and Waveney, and Ipswich local district ethics committees

  • Accepted 2 December 2004
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