Optimising Medicine Information Handover After Discharge (OPTMED-D)

OPTMED-D focuses on reducing avoidable medication-related hospital readmissions by optimising medicine information handover during transition of care. This study is funded by the Medical Research Future Fund. 

Participating sites

  • Gold Coast University Hospital
  • Robina Hospital
  • Princess Alexandra Hospital
  • Queen Elizabeth II Jubilee Hospital
  • Logan Hospital
  • Redland Hospital
  • Beaudesert Hospital

Background

Medication-related harm is a significant public health issue and is an Australian National Health Priority, with the post-hospital discharge period particularly high-risk. When a patient is discharged from hospital, it is essential that their GP and community pharmacist are informed of changes to their medicines to continue their medicine management in the community. However, the handover of medicine information is inconsistent, and it is not standard practice for hospital clinicians to contact a patient’s community pharmacist or GP upon discharge. The disconnect between different health services in hospital and primary care settings impacts patient safety, leading to hospital readmissions and increased cost to the healthcare system.

Our vision is for patients to experience seamless medicine information handover during transitions of care from acute care settings to community care.

We are engaging stakeholders and end-users to co-design a multifaceted intervention that follows the patient's transition of care journey, placing the patient at the centre of care. Our intervention leverages existing transition of care strategies (e.g., discharge summaries) while introducing targeted innovations: a structured medicine handover process and a digital intervention.

Get involved

The study is currently evaluating the implementation of a hospital pharmacist navigator in seven hospitals in Gold Coast and Brisbane South in a stepped wedge cluster randomised controlled trial. Primary care pathways to be initiated by the navigator include post-discharge medication management reviews by community pharmacist (medium risk patients - MedsCheck) and credentialed pharmacists (high risk patients - Home Medicines Review).

As part of the study, we are offering to connect interested GPs with credentialed pharmacists within the Gold Coast and Brisbane South PHN areas. If you (as a credentialed pharmacist) would like to be a part of this, please complete the credentialed pharmacist service details form.

Adjunct Associate Professor Laetitia Hattingh is a research pharmacist with experience in a variety of settings: community and hospital pharmacy, pharmaceutical governance, implementation of medication reviews services (Gold Coast and Tweed Valley Divisions of General Practice) and academia (Griffith and Curtin Universities). In her current role with Gold Coast Health, Hattingh works with clinicians and executives to develop and implement strategies to identify research priority areas and develop research frameworks to evaluate medicine handover at transition of care, new services models and medication safety initiatives.

Professor Elizabeth Manias is a Research Professor at the School of Nursing and Midwifery at Monash University. Her research interests and expertise involve health care communication, patient safety, transitions of care, and risk management. She works with diverse health professionals, including doctors, nurses, pharmacists, and with patients and families, to consider the complexities of how patients and their families can engage in managing medications and facilitating communication between patients and health professionals, as patients move between different settings, such as between hospital and home.

Dr Fei Si is a Senior Lecturer in Pharmacy Practice at Curtin University, WA. She is a registered pharmacist with extensive experience in pharmacy practice, academia, industry, and pharmaceutical aged care services. She is the National President and Chair of the Pharmaceutical Society of Australia (PSA) Board. Fei is the current Chair of the Australian Pharmacy Leaders Forum (APLF), an independent coalition of senior decision-makers from national pharmacy organisations who work together on issues of national importance to the pharmacy profession and the public. She was the inaugural Chair of the Contemporary Community Pharmacy Practice (CCPP) Communities of Specialty Interest, which is a forum to support collaboration, innovation and strategic progression of various practice areas in pharmacy. She is a Fellow of the UK Higher Education Academy and a Fellow of the PSA, and a Graduate Member of the Australian Institute of Company Directors. She brings expertise and first-hand experience in community pharmacy-based service implementation and evaluation.

Dr Holly Foot is an early career clinical pharmacy researcher who aims to improve the outcomes of patients and consumers through supporting safe medication use. Dr Foot led the coordination, delivery, and publication of the REMAIN HOME study (under leadership of AI Freeman and CI Scott), the largest evaluation of pharmacists collaborating with GPs to reduce readmission to hospital in Australia, using a stepped wedge, cluster design. In addition, Dr Foot recently completed a role as a Research Fellow at The University of Auckland (New Zealand), where she led the development, coordination and implementation of a community-pharmacy led intervention to reduce reliever reliance in individuals with asthma.

Dr Faith R. Yong is a pharmacist researcher with a keen interest in improving the quality of care in health systems by addressing workforce challenges, professional identity, safety and quality, and organisational conflicts within and between professions. She has taught in universities for the last six years, and has experience in research within general practice, community, hospital pharmacy practice and medical education. Faith’s research interests include theoretically based qualitative and participatory action research to understand and improve healthcare work and practitioner wellbeing from a systems perspective. She is an experienced community pharmacist and co-administrator of the Consultant Pharmacists Australia group.

Professor Melissa Baysari (BPsych, PhD, FAIDH) leads the Digital Health Human Factors Research Group at the University of Sydney. Her research seeks to improve healthcare delivery via optimising the fit between healthcare professionals and the technologies they use in practice, with a particular focus on digital health tools to support medication management. Professor Baysari has published widely in the areas of medication safety, decision support systems and technology evaluation and she has secured many research grants and consultancies as a CI, totalling over AUD$12 million. Professor Baysari’s research is highly applied and has led to significant changes to technology design, training programs, and policies.

Professor Ian Scott has 35 years of experience practising as a general physician, clinical epidemiologist, and health service researcher in a tertiary teaching hospital and as a professor of medicine at UQ. He has participated in clinical trials of advance care planning, deprescribing, and quality use of medications with pharmacists integrated into general practice. Professor Scott established the Australian Deprescribing Network in 2014 which currently comprises more than 400 researchers and clinicians which has led education and policy reform on inappropriate polypharmacy in this country and overseas, with methods being widely adopted in UK, US, Singapore, and China. He is a fellow of the Royal Australasian College of Physicians, member and past president of the Internal Medicine Society of Australia and New Zealand, and founding member of the Australian and New Zealand Affiliate of the Society of Improving Diagnosis in Medicine.

Professor Gerben Keijzers is a senior Staff Specialist in Emergency Medicine and clinician-researcher at Gold Coast Health with a conjoint adjunct Professor position with Bond University. He has leadership roles as part of several collaborative research groups state-wide and nationally (ACEM, EDCRG). Professor Keijzers leads programs of research in areas of appropriate use of resources, sepsis, and respiratory emergencies, with a specific interest in studies where the focus is on the combination of better outcomes for patients, more convenience for staff and less resource requirement for the health system. 

Professor Claire Jackson has been active in integrated care innovation, education and research since the early '90s, and more recently, extensively involved in health services research and reform. She has been a member of all 4 national Primary Health Care Strategy and Reform Reference Groups - guiding forces behind Australia’s National Health Reform Agreements. Her description of the ‘beacon’ practice model, piloted at Inala Primary Care, was adopted as both the clinical prototype for the Australian Association of Academic General Practitioner’s endorsed model for GP Superclinics, and the basis for UQ’s successful $10 million Superclinic tenders.  Inala Primary Care won RACGP Qld ‘Practice of the Year’ in 2009. 

Professor Mark Morgan has over 20 years of ongoing Australian general practice experience that spans rural, regional, and urban practice. He has held leadership roles at Bond University including Phase Lead for clinical education and Associate Dean for External Engagement. He is a leader within the RACGP as chair of the Expert Committee for Quality Care, holding many representative roles related to national primary care policy. Professor Morgan has a strong international standing in primary care research, policy and clinical guideline development. His international research collaborations have investigated patient safety and primary care microsystems. Quality use of medicines has been the focus of his national research and research-translation activities.

Professor Barbara Mullan’s primary research interests and expertise lie in the use of social cognition models in predicting, changing, and improving health behaviours. Professor Mullan works across a wide range of chronic conditions (e.g. stroke, autoimmune diseases) and clinical populations (e.g. people with diabetes or cancer). Much of her research focuses on the design of innovative theory-based interventions to support and prompt behaviour change. She is in the top 2.5% of researchers on Researchgate and has an H-Index of 61 (Google Scholar), more than 11600 citations, 225 journal articles, 6 book chapters and 4 books. 

Associate Professor Richard Norman is a Health Economist with ongoing interest in the economic evaluation of healthcare, the measurement and valuation of quality of life, discrete choice experiments and econometric analysis of large panel datasets. He holds an BA(Hons) in Philosophy and Economics and an MSc in Health Economics, both from the University of York in the UK, and a PhD from the University of Technology Sydney. He held an NHMRC Early Career Research Fellowship to explore patterns and preferences around quality of life. He is a Chief Investigator on projects currently funded by the NHMRC and the ARC. He is an associate editor of Value in Health, and is a permanent member of the Economics Sub-Committee of the Pharmaceutical Benefits Advisory Committee (PBAC). 

Dr Melanie Bailey is a Research Pharmacist and PhD candidate. She has a background as a veterinarian, and has completed a Master of Pharmacy at Griffith University. As a registered pharmacist, she is currently working as a research pharmacist and completing a full-time PhD candidature with the University of Queensland. She aims to continue a career in research involving information transfer between health care settings in transitions of care. 

Dr Amy Tan is a Senior Principal Research Officer. She has a background in pharmacy. She has wide-ranging research experience in fall prevention in older people and dementia involving general practice, allied health in primary care, older people living in the community and residential aged care.

Edgar Poon is a Senior Research Officer, and is an early-career pharmacist and researcher with experience in leading quality improvement projects, focusing on quality use of medicines and medication safety. His research interests include mental health, emergency medicine, and patient blood management. Edgar is currently employed by Metro South Health and Gold Coast Hospital and Health Services as a research officer across multiple projects, while continuing to work as a senior pharmacist in the clinical setting.

Dr Saira Mathew is a Research Project Manager and is responsible for coordinating the study’s day-to-day delivery across participating sites. With a background in project management, policy implementation, and evidence-based health research, she brings experience leading multidisciplinary teams, managing budgets, and overseeing ethics and governance processes to ensure the study runs smoothly and meets its objectives. She also supports study implementation, stakeholder engagement, data management, and the translation of research findings into practice.

Our governance structure gives project partners, stakeholders and the research team maximum oversight and input into the design, execution, implementation and translation of this research — spanning the leadership, operational and recruitment aspects of the project.

Project Leadership Group

Made up of all project investigators, overseeing overall progress and milestones. An Operational Unit meets more frequently to manage day-to-day operational matters.

Meets: Monthly (Operational Unit: fortnightly)

Members: Project CIs and research team

Consumer Reference Group

Provides advice to the research team on the project's direction and approach, with a focus on consumer involvement and engagement. Members review preliminary findings from each project phase, offering their perspective and lived experience to help maximise the project's impact.

Meets: Every four months

Members:

  • Letisha Living
  • Leah Matthews
  • Jasmine Magele-Trimble
  • Peter Button

 

Steering Committee

Provides strategic advice on the implementation and evaluation of all three phases of the study. Advises on strategies to overcome challenges and barriers the study faces, and provides feedback and support for engaging consumers and clinicians in the study.

Meets: Every four months

Members:

  • Professor, Griffith University — Chair
  • Principal Investigator, Metro South
  • Consumer Reference Group Representative, OPTMED-D
  • General Practitioner; RACGP
  • Pharmaceutical Society of Australia
  • Primary Health Care, Gold Coast Primary Health Network
  • Primary Health, Brisbane South Primary Health Network
  • Gold Coast University Hospital
  • Metro South Hospital and Health Service
  • The Pharmacy Guild of Australia

 

Digital Health Committee

Oversees the development, implementation and evaluation of the digital intervention. Advises on scope and priority areas, brings expert insight on contextual factors such as infrastructure and policy, reviews findings from Phases 1 and 2 as they relate to the digital intervention, and provides strategic guidance on its rollout and evaluation.

Meets: Every two months, or as needed

Members:

  • Director, Centre for Health System Reform and Integration
  • Medical Director Digital and Information, Gold Coast Hospital and Health Service
  • A/Director Data and Analytics, Metro South Hospital and Health Service 
  • Medications Systems Manager, Metro South Hospital Clinical Informatics 
  • Brisbane South Primary Health Network
  • Digital Health Lead, Pharmaceutical Society of Australia
  • A/Director Clinical Informatics, Office of the Chief Clinical Information Officer
  • Pharmacist Advanced – Clinical Informatics, Gold Coast Hospital and Health Service
  • Strategy, Architecture and Information Service Branch, eHealth Queensland
  • Director of Clinical Informatics- Medications, Office of the CCIO, Queensland Health
  • Consumer Representative
  • Carer Representative 

 

Directors of Pharmacy Working Group

Advises on the implementation and ongoing facilitation of the stepped-wedge cluster randomised trial (SW-CRT) from a hospital pharmacy perspective.

Meets: Monthly

Members:

  • Director of Pharmacy, Gold Coast University Hospital
  • A/Director of Pharmacy, Robina Hospital
  • Director of Pharmacy, Logan and Beaudesert Hospital
  • A/Director of Pharmacy, Redland Hospital
  • Director of Pharmacy, Queen Elizabeth II Jubilee Hospital
  • Director of Pharmacy, Princess Alexandra Hospital

 

Safety Committee

An independent, four-member group tasked with identifying and advising on project safety issues throughout the study.

Meets: As needed, throughout the project

Members: pharmacist navigator, community pharmacist, GP and consumer.

Funding

This study is funded by the Medical Research Future Fund.

Study partners 

     


     

    Stakeholders

    • Australian Patients Association
    • Australian Association of Consultant Pharmacy
    • PHN Brisbane South and PHN Gold Coast
    • Internal Medicine Society of Australia & New Zealand
    • Society of Hospital Pharmacists of Australia