Predicting the potential value of the new discharge medicines service in England

Abstract

In 2021, community pharmacies in England were commissioned to support patients post-discharge through the discharge medicines service (DMS). Past studies described the benefit of DMS in avoiding readmissions. This study aimed to estimate the impact of DMS in this respect, projecting the maximal benefit if all areas mirrored the most active region. A retrospective observational study, including modelling, using DMS claims data from March 2021 to February 2022, obtained from the NHS Business Services Authority (data from all community pharmacies in England for patients discharged where hospital clinicians referred them to community pharmacy). The impact of DMS on reducing readmission during this period was estimated using previous study data and estimated maximal benefit from full implementation of the service across England. In the study period 65 634 completed DMS claims were made. Claims at Integrated Care System (ICS) area level varied from 509/10 000 admissions to <1/10 000 admissions. Combining data from past studies provides a relative risk ratio of 0.756 (95% CI 0.678 to 0.843) for 90 day readmission (DMS versus normal care). DMS is estimated to have resulted in 8393 (95% CI 7061 to 9564) fewer readmissions after 30 days reducing to 5869 (95% CI 3774 to 7740) after 90 days. If all-ICS areas were as active as the highest performing area, DMS would avoid estimated >29 000 readmissions at 90 days each year. DMS has significant potential to reduce readmissions. DMS implementation is currently variable and full implementation across all-ICS areas could increase the benefits five-fold.