Post discharge medicines use review service for older patients: recruitment issues in a feasibility study

Abstract

Background The community pharmacy medicines use review (MUR) service in England has been identified as a way of providing support with medication to recently discharged patients; however initial uptake of post-discharge MUR has been low. Objective To identify barriers to recruitment into a randomised controlled feasibility study of a hospital referral system to older patients’ regular community pharmacists. Method Ward pharmacists at Southport District General Hospital identified patients aged over 65 to be approached by a researcher to assess eligibility and discuss involvement in the trial. Participants were randomised to referral for a post discharge MUR with their regular community pharmacist, or to standard discharge care. Reasons for patients not participating were collected. Results Over a 9-month period 337 potential participants were identified by ward pharmacists. Of these, 132 were eligible and 60 were recruited. Barriers to recruitment included competing priorities among ward pharmacists, and national restrictions placed on MURs e.g. housebound patients and those requiring carer support with medication. Lack of expected benefit resulted in a high proportion of patient refusals. Conclusion The current provisions for post discharge MURs exclude many older people from participation, including those possibly in greatest need. Unfamiliarity with the role of the pharmacist in transitional care may have affected patients’ perceived ‘cost-benefit’ of taking part in this study.