Improving rural health through implementation of a pharmacist-led post discharge and high-risk medication service in a rural community

Ms Michelle Rothwell1, Ms Sarah Tinney2, Dr Neil Cottrell3

1Queensland Health, Cairns , Australia, 2Cairns and Hinterland Hospital and Health Service, Atherton , Australia, 3University of Queensland , Brisbane, Australia

Introduction: The 2019 report ‘Medicine Safety: Take Care’ states that 250,000 hospital admissions each year are a result of medication-related problems (MRP’s) costing $1.4 billion with 90% of patients having at least one medication-related problem post discharge from hospital. This study determines the impact of a pharmacist-led post discharge and high-risk medication service on medication misadventure.

Methods: Conducted as part of the Queensland Allied Health Rural Generalist Pathway initiative this is a descriptive study utilising quantitative methodology to collect data prospectively as well as pre- and post-intervention. The intervention is a comprehensive pharmacist medication review for patients identified at risk of medication misadventure Primary outcomes are the subjective and objective measured change in medication adherence and the SF-12 health survey quality of life (QOL) score compared to baseline at three and six months post intervention. Secondary outcomes include the number of identified medication-related problems (MRPs), the number of resolved MRPs and the grading of clinical significance of the MRPs.

Results: 81 patients consented with a complete data set presented so far for 50 patients. Preliminary results show an increase in subjective medication adherence for post discharge patients at three months continued through to six months, with the mental component summary of QOL data considerably lower for patients at discharge compared to the high-risk patients and to baseline. 430 MRPs were identified which is an average of 5.31 MRPs per patient.

Conclusions: The high number of identified MRPs per patient emphasises the risk of medication misadventure. Preliminary data suggests the pharmacist intervention improves medication adherence and the effect is sustained. QOL mental component summary data may contribute to evidence that patients in the immediate post discharge period are at most risk of medication misadventure. Further work on this study will complete evaluation data and measure the impact on acute service use.


Sarah Tinney is a hospital pharmacist who has been working in rural hospitals since 2013. She is passionate about improving medication services in rural areas, with particular interests in antimicrobial stewardship, medication safety and deprescribing. Among her achievements, Sarah has implemented a rural multidisciplinary antimicrobial stewardship round at Atherton Hospital, which was highlighted at the 2018 SHPA Medicines Management conference.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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