ABSTRACT
OBJECTIVE: To determine whether a pharmacist visit after hospital dismissal for patients taking at least 1 medication that places patients at high risk for emergent hospital admissions (termed high-risk medication) would decrease the risk of hospital readmission at 30 days compared with usual care. PATIENTS AND METHODS: This was a retrospective study at a tertiary care center conducted from July 26, 2013, through April 1, 2016. We reviewed outcomes among patients who did or did not have a post-hospital dismissal pharmacist visit immediately before a clinician visit. We included patients who were at least 18 years old and were taking at least 10 total medications at hospital dismissal, 1 or more of which were high-risk medications. A Cox proportional hazards model was used to compare the risk of 30-day readmission between the groups. RESULTS: The study cohort included 502 patients in each group (pharmacist + clinician group and clinician-only group). After adjusting for differences in background demographic characteristics, patients in the pharmacist + clinician group were significantly less likely to be readmitted to the hospital within 30 days postdismissal compared with the clinician-only group (hazard ratio, 0.49; 95% CI, 0.35-0.69; P<.001). CONCLUSION: Patients seen by a pharmacist immediately before a clinician visit after hospital dismissal had a lower risk of readmission than patients who had a clinician-only visit. Patients taking high-risk medications for hospital admissions are ideal candidates for pharmacist involvement.
ABSTRACT
BACKGROUND: The optimization of medication use during care transitions represents an opportunity to improve overall health-related outcomes. The utilization of clinical pharmacists during care transitions has demonstrated benefit, although the optimal method of integration during the care transition process remains unclear. OBJECTIVE: To evaluate the impact of pharmacist-provided telephonic medication therapy management (MTM) on care quality in a care transitions program (CTP) for high-risk older adults. METHODS: This prospective, randomized, controlled study was conducted from December 8, 2011, through October 25, 2012, in a primary care work group at a tertiary care academic medical center in the midwestern United States. High-risk elderly (aged ≥60 years) patients were randomized to a pharmacist-provided MTM program via telephone or to usual care within an existing outpatient CTP. The primary outcome was the quality of medication prescribing and utilization based on the Screening Tool to Alert Doctors to the Right Treatment (START) and the Screening Tool of Older Persons' Prescriptions (STOPP) scores. The secondary outcomes were medication utilization using a modified version of the Medication Appropriateness Index, hospital resource utilization within 30 days of discharge, and drug therapy problems. RESULTS: Of 222 eligible high-risk patients, 25 were included in the study and were randomized to the pharmacist MTM intervention (N = 13) or to usual care (N = 12). No significant differences were found between the 2 groups in medications meeting the STOPP or START criteria. At 30-day follow-up, no significant differences were found between the 2 cohorts in medication utilization quality indicators or in hospital utilization. At 30-day follow-up, 3 (13.6%) patients had an emergency department visit or a hospital readmission since discharge. In all, 22 patients completed the study. Medication underuse was common, with 20 START criteria absent medications evident for all 25 patients at baseline, representing 15 (60%) patients with ≥1 missing medications. Overall, 55 drug therapy problems were identified at baseline, 24 (43.6%) of which remained unresolved at 30-day follow-up. CONCLUSION: The use of a pharmacist-provided MTM program did not achieve a significant difference compared with usual care in an existing CTP; however, the findings demonstrated frequent utilization of inappropriate medications as well as medication underuse, and many drug therapy problems remained unresolved. The small size of the study may have limited the ability to detect a difference between the intervention and usual care groups.
