Impact of a transitions of care pilot service established by pharmacy residents within an academic medical center.

OBJECTIVES: The impact of a pharmacy postgraduate year (PGY)-2 resident-led transitions of care (TOC) pilot service targeting patients with chronic obstructive pulmonary disorder (COPD) and heart failure (HF) was evaluated in terms of 30-day hospital readmissions (primary objective) at the University of Louisville Hospital (ULH) and 30-day emergency department (ED) visits at ULH (secondary objective). SETTING: The study was conducted at an urban academic teaching hospital. PRACTICE DESCRIPTION: Before this pilot service, there were no formal TOC services for patients at high risk for readmission to ULH. PRACTICE INNOVATION: The TOC pilot service providing coverage 16 h/week included patients aged at least 18 years admitted to the ULH internal medicine team with a primary or secondary diagnosis of COPD or HF. Patients to be discharged to a location other than home or who could not be contacted after discharge were excluded. The service consisted of pharmacist-patient interactions before discharge; within 72 hours after discharge, over the telephone; and 7-14 days after discharge, in person. EVALUATION: Data were collected by retrospective chart review from patients enrolled between November 2017 and October 2018. For comparison, a computer-generated report identified patients who met the criteria for the pilot service but could not be enrolled. RESULTS: Of the 23 patients enrolled in the TOC pilot service, none required readmission to ULH within 30 days, compared with 12.3% of all other eligible patients. Similarly, no patients enrolled in the TOC pilot service presented to the ED within 30 days after discharge, compared with 18.6% of the comparator group. Completion rates of postdischarge follow-up were 65.2% for the telephone call and 52.2% for the clinic visit. CONCLUSION: PGY-2 ambulatory care pharmacy residents implemented a new TOC service that contributed to lower rates of 30-day readmissions and ED visits than those for other eligible patients.

Safety and efficacy of dolutegravir in hemodialysis.

With the increasing incidence of chronic kidney disease in patients with human immunodeficiency virus (HIV), the number of HIV-infected patients requiring hemodialysis has also increased. Dolutegravir is an integrase inhibitor that is a common component of HIV treatment regimens. Currently, there is no guidance regarding the use of dolutegravir in patients requiring hemodialysis. Therefore, we sought to evaluate the clinical correlates of safe and effective use of dolutegravir in hemodialysis. This was a retrospective cohort analysis of patients receiving dolutegravir and hemodialysis for at least six months at a single academic HIV medical clinic. The primary safety outcome was discontinuation of dolutegravir due to an adverse effect. The primary efficacy outcome was viral suppression six months after being on dolutegravir and hemodialysis simultaneously. Ten patients received dolutegravir while receiving hemodialysis for six months. No patients discontinued the medication during the six months. Eighty percent of the patients were virally suppressed at six months with 62.5% of those suppressed maintaining suppression and 37.5% achieving suppression over the course of the six months. In a retrospective review of ten patients receiving dolutegravir while on hemodialysis for at least six months, dolutegravir was generally safe and effective for use at standard dosages.