Background: Heart failure readmission has been national public health problems for many years. Medication reconciliation in elderly patients is important because the impact of medication intervention in elderly is critical to reduce readmission. There was no enough study to assess readmission or emergency room visit for elderly patients after resident physician level medication reconciliation at the time of discharge. The aim of this study is to determine whether providing a bag to hospitalized geriatric patients for heart failure exacerbation at the time of discharge will improve the rate of hospital readmission or visiting emergency department within 30 days after hospital discharge.
Method: We conducted a randomized prospective cohort study with 265 patients with heart failure exacerbation above 65 years of age for one year. When patients were discharged to home, the family member or home attendants were called to bring all bottles to the hospital prior to discharge. Patients and their caregivers were educated by residents in charge about the discharge medications to bring the medications to their next clinic visits. We designed small transparent plastic bags for patients to recognize the medication easily through the bag. The interventional group was provided with a plastic bag to carry the newly reconciled medications along with teaching about the medications and the control group was only given information about their medications.
Results: 265 patients with heart failure exacerbation for admission were enrolled in our study. The mean age in our study population was 73.4±8.1 and 74.8±8.1 years old in the intervention and control groups, respectively (P=0.82). There was 66/141 (46.8%) and 63/124(54.8%) males in the intervention and control groups, respectively (P = 0.81). 3/141(2.12 %) of intervention patients and 7/124(5.64%) of control patients were readmitted (P = 0.11). And 2/124(1.61 %) of control patients and 0/141(0.0%) of intervention patients revisited walk-in clinic respectively (P = 0.13). There were no reported adverse medication events.
Conclusion: In this study, the use of a bag to facilitate medication reconciliation at the level of medical resident physician was not associated with a significant difference in unplanned readmissions or in revisiting walk-in clinics within 30 days after discharge. We may conclude that patients with chronic medical condition might not be reversible only by medication reconciliation. It may need personalized discharge planning as well as medication reconciliation beyond only physician level because heart failure patients were basically at the high risk of readmission by themselves.