BMJ  2005;330:293 (5 February), doi:10.1136/bmj.38338.674583.AE (published 21 January 2005)

Primary care

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

Richard Holland, senior lecturer in public health medicine1, Elizabeth Lenaghan, senior research associate1, Ian Harvey, professor of epidemiology and public health1, Richard Smith, reader in health economics1, Lee Shepstone, reader in medical statistics1, Alistair Lipp, director of public health2, Maria Christou, education pharmacist3, David Evans, specialist adviser, pharmaceutical services4, Christopher Hand, honorary senior lecturer1

1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, 2 Great Yarmouth Teaching Primary Care Trust, Astley Cooper House, Estcourt Road, Great Yarmouth, Norfolk NR14 8AB, 3 Academic Pharmacy Practice Unit, University of East Anglia, Norwich NR4 7TJ, 4 Suffolk Public Health Network, Suffolk House, St Clement's, Foxhall Road, Ipswich IP3 8LS

Correspondence to: R Holland r.holland{at}uea.ac.uk

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by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed.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


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Study shows wrong people, wrong skills, wrong tools . . .
Duncan R Petty and Arnold Zermansky
BMJ 2007 334: 1180. [Extract] [Full Text] [PDF]

Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial
Richard Holland, Iain Brooksby, Elizabeth Lenaghan, Kate Ashton, Laura Hay, Richard Smith, Lee Shepstone, Alistair Lipp, Clare Daly, Amanda Howe, Roger Hall, and Ian Harvey
BMJ 2007 334: 1098. [Abstract] [Full Text] [PDF]

"I haven't even phoned my doctor yet." The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: qualitative discourse analysis
Charlotte Salter, Richard Holland, Ian Harvey, and Karen Henwood
BMJ 2007 334: 1101. [Abstract] [Full Text] [PDF]

Home based medication reviews fail to improve outcomes
BMJ 2005 330: 0. [Full Text]

Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data
Martin Roland, Mark Dusheiko, Hugh Gravelle, and Stuart Parker
BMJ 2005 330: 289-292. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • Setter, S. M., Corbett, C. F., Neumiller, J. J., Gates, B. J., Sclar, D. A., Sonnett, T. E. (2009). Effectiveness of a pharmacist-nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care. Am J Health Syst Pharm 66: 2027-2031 [Abstract] [Full text]  
  • Petersen, L. A., Woodard, L. D., Henderson, L. M., Urech, T. H., Pietz, K. (2009). Will Hypertension Performance Measures Used for Pay-for-Performance Programs Penalize Those Who Care for Medically Complex Patients?. Circulation 119: 2978-2985 [Abstract] [Full text]  
  • Castelino, R. L, Bajorek, B. V, Chen, T. F (2009). Targeting Suboptimal Prescribing in the Elderly: A Review of the Impact of Pharmacy Services. The Annals of Pharmacotherapy 43: 1096-1106 [Abstract] [Full text]  
  • Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., Forsythe, S. R., O'Donnell, J. K., Paasche-Orlow, M. K., Manasseh, C., Martin, S., Culpepper, L. (2009). A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial. ANN INTERN MED 150: 178-187 [Abstract] [Full text]  
  • Spice, C. L., Morotti, W., George, S., Dent, T. H. S., Rose, J., Harris, S., Gordon, C. J. (2009). The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people. Age Ageing 38: 33-40 [Abstract] [Full text]  
  • Triller, D. M., Hamilton, R. A. (2007). Effect of pharmaceutical care services on outcomes for home care patients with heart failure. Am J Health Syst Pharm 64: 2244-2249 [Abstract] [Full text]  
  • Alter, D. A. MD PhD (2007). Therapeutic lifestyle and disease-management interventions: pushing the scientific envelope. CMAJ 177: 887-889 [Full text]  
  • Cresswell, K. M., Fernando, B., McKinstry, B., Sheikh, A. (2007). Adverse drug events in the elderly. Br Med Bull 83: 259-274 [Abstract] [Full text]  
  • Petty, D. R, Zermansky, A. (2007). Study shows wrong people, wrong skills, wrong tools . . .. BMJ 334: 1180-1180 [Full text]  
  • Salter, C., Holland, R., Harvey, I., Henwood, K. (2007). "I haven't even phoned my doctor yet." The advice giving role of the pharmacist during consultations for medication review with patients aged 80 or more: qualitative discourse analysis. BMJ 334: 1101-1101 [Abstract] [Full text]  
  • Holland, R., Brooksby, I., Lenaghan, E., Ashton, K., Hay, L., Smith, R., Shepstone, L., Lipp, A., Daly, C., Howe, A., Hall, R., Harvey, I. (2007). Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial. BMJ 334: 1098-1098 [Abstract] [Full text]  
  • Lenaghan, E., Holland, R., Brooks, A. (2007). Home-based medication review in a high risk elderly population in primary care--the POLYMED randomised controlled trial. Age Ageing 36: 292-297 [Abstract] [Full text]  
  • The Community Pharmacy Medicines Management Projec, (2007). The MEDMAN study: a randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease. Fam Pract 24: 189-200 [Abstract] [Full text]  
  • Zermansky, A. G., Alldred, D. P., Petty, D. R., Raynor, D. K., Freemantle, N., Eastaugh, J., Bowie, P. (2006). Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial. Age Ageing 35: 586-591 [Abstract] [Full text]  
  • Howard, R. L., Avery, A. J. (2006). Pharmacist-led medication reviews can reduce patient morbidity?. Age Ageing 35: 555-556 [Full text]  
  • Gorard, D.A. (2006). Escalating polypharmacy. QJM 99: 797-800 [Abstract] [Full text]  
  • Holland, R., Smith, R., Harvey, I. (2006). Where now for pharmacist led medication review?. J. Epidemiol. Community Health 60: 92-93 [Full text]  
  • Muijrers, P. E., Grol, R. P., Sijbrandij, J., Janknegt, R., Knottnerus, J A. (2005). Differences in prescribing between GPs. Impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives. Fam Pract 22: 624-630 [Abstract] [Full text]  
  • Lehman, R. (2005). Evidently.... Evid. Based Med. 10: 72-72 [Full text]  
  • (2005). Other articles noted. Evid. Based Med. 10: 95-96 [Full text]  

Rapid Responses:

Read all Rapid Responses

Pharmacist Medication Review Study Design Concerns
Joel W Hay
bmj.com, 28 Jan 2005 [Full text]
Drug Interactions
Roger C Hayter
bmj.com, 30 Jan 2005 [Full text]
Re: Drug Interactions
John david leopold
bmj.com, 4 Feb 2005 [Full text]
Pharmacist Medication Review
Michael G Scott, et al.
bmj.com, 4 Feb 2005 [Full text]
Could increased readmission be linked to increase General Practitioner visits?
Richard L Davies
bmj.com, 6 Feb 2005 [Full text]
Study design should go beyond answering a single question of Outcome
Abdullah Mohammed
bmj.com, 9 Feb 2005 [Full text]
Response to HOMER trial paper
David R Green
bmj.com, 10 Feb 2005 [Full text]
HOMER trial was not a clinical medication review
Duncan Robert Petty, et al.
bmj.com, 16 Feb 2005 [Full text]
Authors' response to comments on the HOMER trial
Richard Holland, et al.
bmj.com, 7 Mar 2005 [Full text]
Pharmacist Medication Reviews
Caroline S Bowyer, et al.
bmj.com, 9 Mar 2005 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ