Medicines management support for recently discharged patients: coordinated, needs-assessed approach

Amanda Powell, Pharmacist Primary Care and Intermediate Care

Dr Stuart Gray, Prescribing Lead Llwyncelyn Practice, Whitchurch

Cardiff and Vale University Health Board

This Bevan Exemplar project aimed to assess and meet the medicines management needs of every patient discharged to a GP practice.


It is recognised that not enough support is given to patients to manage their medicines after discharge from hospital. Most at risk are the frail elderly who may not be able to access the usual community pharmacy resources.

The intervention

All recently discharged patients (105) were assessed over 4 months in one GP practice.

Patients were assessed as needing one of the following interventions:

Criteria for assessment included age, number of admissions in past 6 months, duration of admission, co-morbidities, number of medicines and number of medicines changes at discharge.


Only 39% of DMR referrals were acted upon by the community pharmacy. Reasons included patient not contactable, patient declined, time constraints, no internal communication of referral, IT issues.


For very little time investment (1-2 hours of a pharmacy technician, band 5) per week, it was possible to assess all discharges. A small proportion of patients, those with the greatest need, were visited at home where their understanding and adherence to their medicines regimen could be assessed and adapted as necessary. Every patient visited at home had input from the pharmacy team.

Home Visit – Stan’s Story:

Discharge Medicines Review (DMR) In Action – Kenneth’s Story

Next steps

“…appreciated the visit – a worthwhile cause.”

Patient, visited at home

“We have learnt that better communication with patients who do not
have MCAs (multi-compartment compliance aids) is needed.”

Community Pharmacist

Part of cohort Bevan Exemplar Projects 2018-19