Reducing 30-Day All-Cause Rehospitalizations: A Pharmacist-Led Telehealth Service.

BACKGROUND: Use of skilled nursing facilities (SNFs) has grown as an intermediary step for patients unready to discharge to lower acuity care settings. Discharge planning from SNFs has become a critical component of the care continuum and may impact patient outcomes and facility payment status. Currently, the discharge process does not include a pharmacist-led comprehensive medication review.
OBJECTIVES: To determine the impact of a pharmacistdriven discharge consultation service on 30-day allcause rehospitalization. Secondary outcomes included hospital readmission diagnosis, discharge consultation times, number of pharmacist interventions, and patient satisfaction.
METHODS: The institutional review board approved this prospective cohort with a historical control pilot study to evaluate patients discharging from SNFs. Patients who provided informed consent were enrolled to participate in a video consultation service at the time of discharge. The primary outcome measured was 30-day hospital readmission rate postdischarge compared with one year prior.
RESULTS: One hundred ninety-six counseling sessions were performed at three facilities. The average time per discharge was 15.4 ± 3.3 minutes, average number of medications was 15.5 ± 6.2, and average Charlson Comorbidity Index was 5.6 ± 2.2. Patient readmission data were tracked by diagnosis and reported by facility.
CONCLUSION: A positive correlation between reduced readmission rates and participation in consultation service were observed. Second, positive patient satisfaction surveys indicated patients value medication education. The use of a pharmacist-led telehealth service like the one described in this study may lead to a reduction in facility readmission penalties and improve patient access to pharmacist services in remote locations.

Correlation of the Pharmacy Curriculum Outcomes Assessment and Selected Pre-pharmacy and Pharmacy Performance Variables.

Objective. To identify the correlation between the Pharmacy Curriculum Outcomes Assessment (PCOA) and pre-pharmacy and pharmacy performance variables. Methods. Four years of PCOA data (2012-2015) were analyzed for students taking the assessment in the third professional year (P3). Using the Pearson correlation coefficient, data was correlated to a series of performance variables: pre-pharmacy grade point average (GPA), pre-pharmacy science GPA (pre-pharmacy science courses only), Pharmacy College Admission Test (PCAT) composite score, P3 pre-advanced pharmacy practice experience (APPE) GPA and the North American Pharmacist Licensure Examination (NAPLEX). Scores that were correlated at r ≥ 0.30 were added to a multivariate linear regression model to compare their unique contributions. Results. There was a moderate correlation between PCOA and PCAT (r=0.60), P3 pre-APPE GPA (r=0.60) and the NAPLEX (r=0.64). The multivariate regression analysis explained 60% of the variance of the total PCOA score, with PCAT making the largest unique contribution. Conclusion. The PCOA was moderately to strongly correlated to the pre-APPE GPA, thus providing an acceptable assessment of student learning. The PCOA was also moderately to strongly correlated to the NAPLEX, making it a useful tool in predicting performance and identifying students in need of further remediation before the NAPLEX.

Management of hypertension in liver transplant patients.

Hypertension is a common co-morbidity and a frequent complication in liver transplant patients. The aim of this paper is to concisely review available clinical data and propose a hypertension treatment algorithm in liver transplant patients. Calcium channel blockers are mainstay of the treatment due to their potent vasodilatory effects. Dihydropyridine calcium channel blockers are preferable due to their least interaction with cytochrome P450 enzyme system and, therefore, minimal risk of potential disruption of immunosuppressive drug levels. Beta-blockers may be considered first line drugs in patients with resting tachycardia and in those with high cardiac outputs. Data support the use of beta-blockers for patients intolerant or unresponsive to calcium channel blockers. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have little value when used early after liver transplant but may have a more pronounced role during the later periods. Diuretics may be of value in combination with other drugs, especially to counteract the potassium-retaining effects of calcineurin inhibitors. Treatment of post liver transplantation hypertension in patients with co-morbid conditions such as coronary artery disease, diabetes mellitus, congestive heart failure, and renal disease will likely require combination therapy.