1
|
Nummedal MA, King S, Uleberg O, Pedersen SA, Bjørnsen LP. Non-emergency department (ED) interventions to reduce ED utilization: a scoping review. BMC Emerg Med 2024; 24:117. [PMID: 38997631 PMCID: PMC11242019 DOI: 10.1186/s12873-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. METHODS This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population. RESULTS Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients' homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions. CONCLUSION A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.
Collapse
Affiliation(s)
- Målfrid A Nummedal
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sarah King
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddvar Uleberg
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sindre A Pedersen
- The Medicine and Health Library, Library Section for Research Support, Data and Analysis, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Petter Bjørnsen
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
2
|
Merdad M, Alqutub A, Mogharbel A, Farid A, Bayazed A, Alghamdi A, Albogami Y, Alshehri R, Alnefaie MN, Alamoudi HA. Rate and Causes of Unplanned Hospital Returns within 60 Days following Head and Neck Surgery. Int Arch Otorhinolaryngol 2024; 28:e481-e486. [PMID: 38974639 PMCID: PMC11226301 DOI: 10.1055/s-0044-1779433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/26/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score ( p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits.
Collapse
Affiliation(s)
- Mazin Merdad
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulsalam Alqutub
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Mogharbel
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah Farid
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah Bayazed
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz Alghamdi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Yazeed Albogami
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Rayan Alshehri
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Majed N. Alnefaie
- Department of Otolaryngology, Head and Neck Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Hanin A. Alamoudi
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| |
Collapse
|
3
|
Merdad M, Alqutub A, Mogharbel A, Alghamdi AA, Alsulami O, Awadh M, Alsulami AS. Rate and Causes of 30-day Unplanned Readmission/Return Following Head and Neck Surgery at a Tertiary Care Center in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:162-168. [PMID: 38764562 PMCID: PMC11098266 DOI: 10.4103/sjmms.sjmms_138_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/17/2023] [Accepted: 10/08/2023] [Indexed: 05/21/2024]
Abstract
Background Identifying and targeting common preventable causes of 30-day hospital readmissions could help improve survival rates and reduce the healthcare burden. Objective To determine the rate and causes of unplanned hospital return/readmission to the Outpatient Department (OPD) or Emergency Department (ED) within 30 days after discharge following head and neck surgery (HNS) at a tertiary hospital in Western Saudi Arabia. Methods This retrospective study included all adult patients (aged ≥18 years) who had undergone HNS at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2015 and December 2022 and returned to the OPD or ED within 30 days of being discharged. Results Of 1041 patients who had undergone HNS, 84 (8.1%) returned to the hospital within 30 days after discharge: 63 (6.1%) to the OPD and 21 (2.0%) to the ED. A total of 9 (0.9%) patients were readmitted as inpatients, most commonly for infections (33.3%) and neurological symptoms, including weakness and seizures (22.2%). For OPD visits, common causes were wound swelling (25.4%) and neurological symptoms (17.5%). For ED returns, frequent causes were neurological symptoms (23.8%) and surgical site bleeding (19.1%). Readmission was associated with intensive care unit (ICU) admission during the primary hospital stay (P = 0.003) and higher preoperative baseline health burdens when examined using the American Society of Anesthesiology score (P = 0.022), the Cumulative Illness Rating Scale (P = 0.007), and the Charlson Comorbidity Index (CCI) (P = 0.006). Conclusion The rate of 30-day unplanned hospital return following head and neck surgery was 6.1% and 2.0% through the OPD and the ED, respectively; 0.9% were readmitted as inpatients. Common causes of return included wound swelling, infections, bleeding, and neurological symptoms.
Collapse
Affiliation(s)
- Mazin Merdad
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulsalam Alqutub
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Mogharbel
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdullah A. Alghamdi
- Department of Otolaryngology-Head and Neck Surgery, King Fahad General Hospital, Al-Baha, Saudi Arabia
| | - Omar Alsulami
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Awadh
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed S. Alsulami
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Ruiz-Ramos J, Plaza-Diaz A, Roure-i-Nuez C, Fernández-Morató J, González-Bueno J, Barrera-Puigdollers MT, García-Peláez M, Rudi-Sola N, Blázquez-Andión M, San-Martin-Paniello C, Sampol-Mayol C, Juanes-Borrego A. Drug-Related Problems in Elderly Patients Attended to by Emergency Services. J Clin Med 2023; 13:3. [PMID: 38202010 PMCID: PMC10779430 DOI: 10.3390/jcm13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
The progressive aging and comorbidities of the population have led to an increase in the number of patients with polypharmacy attended to in the emergency department. Drug-related problems (DRPs) have become a major cause of admission to these units, as well as a high rate of short-term readmissions. Anticoagulants, antibiotics, antidiabetics, and opioids have been shown to be the most common drugs involved in this issue. Inappropriate polypharmacy has been pointed out as one of the major causes of these emergency visits. Different ways of conducting chronic medication reviews at discharge, primary care coordination, and phone contact with patients at discharge have been shown to reduce new hospitalizations and new emergency room visits due to DRPs, and they are key elements for improving the quality of care provided by emergency services.
Collapse
Affiliation(s)
- Jesús Ruiz-Ramos
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| | - Adrián Plaza-Diaz
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| | - Cristina Roure-i-Nuez
- Pharmacy Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (C.R.-i.-N.); (J.F.-M.)
| | - Jordi Fernández-Morató
- Pharmacy Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (C.R.-i.-N.); (J.F.-M.)
| | - Javier González-Bueno
- Pharmacy Department, Hospital Dos de Maig Consorci Sanitari Integral, 08025 Barcelona, Spain; (J.G.-B.); (M.T.B.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic-Universitat Central de Catalunya, 08500 Vic, Spain
| | | | - Milagros García-Peláez
- Pharmacy Department, Hospital General de Granollers, 08402 Granollers, Spain; (M.G.-P.); (N.R.-S.)
| | - Nuria Rudi-Sola
- Pharmacy Department, Hospital General de Granollers, 08402 Granollers, Spain; (M.G.-P.); (N.R.-S.)
| | - Marta Blázquez-Andión
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
- Emergency Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Carla San-Martin-Paniello
- Strategy and Innovation Office (Més Sant Pau), Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.S.-M.-P.); (C.S.-M.)
| | - Caterina Sampol-Mayol
- Strategy and Innovation Office (Més Sant Pau), Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.S.-M.-P.); (C.S.-M.)
| | - Ana Juanes-Borrego
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| |
Collapse
|
5
|
Joseph Macchiavelli A. Venous Thromboembolism: The Need for Transitions of Care. Med Clin North Am 2023; 107:883-894. [PMID: 37541714 DOI: 10.1016/j.mcna.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
The Centers for Disease Control and Prevention estimates that approximately 900,000 patients are diagnosed with venous thromboembolism (VTE) annually in the United States leading to approximately 548,000 hospitalizations and 100,000 deaths. Approximately 274 people die daily in the United States from VTE. The numbers are staggering with 1 person dying every 5 minutes! There are more deaths annually in the United States from VTE than breast cancer (41,000), AIDS (16,000), and motor vehicle accidents (32,000) combined! VTE is recognized as a leading cause of preventable hospital deaths and a leading cause of maternal deaths.
Collapse
Affiliation(s)
- Anthony Joseph Macchiavelli
- Division Vascular Medicine, Jefferson Vascular Center, Sidney Kimmel Medical College, 111 South 11th Street, 6210 Gibbon, Philadelphia, PA 19107, USA.
| |
Collapse
|
6
|
Althagafi A, Alshibani M, Alshehri S, Alqarni A, Baharith M, Alqurashi S. Evaluation of Pharmacy-Led Post-Discharge Follow-Up on Transitional Care Management in a Tertiary Academic Hospital: An Observational Study. Cureus 2023; 15:e43477. [PMID: 37711919 PMCID: PMC10499055 DOI: 10.7759/cureus.43477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION The administration of multiple medications and complex drug regimens has increased medication-related problems (MRPs) and associated factors. MRPs can occur at any stage of the medication process and are common after hospital discharge. Understanding and managing these problems are crucial for promoting safe and effective medication use. OBJECTIVE This study aimed to evaluate the prevalence of MRPs among post-discharge patients with high medication risk in the academic tertiary care hospital of King Abdulaziz University (KAUH) in Jeddah, Saudi Arabia. METHODS A prospective cross-sectional study was conducted, and data were collected through phone calls to discharged patients using validated questions. MRPs were identified based on the classification of the Pharmaceutical Care Network Europe (PCNE), and data analysis was performed using descriptive statistics. RESULTS Out of 287 screened participants, 201 fulfilled the inclusion criteria. The prevalence of MRPs among high-medication-risk patients after hospital discharge was substantial, with 519 MRPs identified. The most common types of MRPs were the need for medication information, untreated symptoms or indications, and nonadherence. CONCLUSION The most prevalent MRPs among patients in our hospital were the need for education and untreated symptoms or indications. Future studies should investigate MRPs in larger samples and explore interventions by pharmacists.
Collapse
Affiliation(s)
| | | | - Samah Alshehri
- Clinical Pharmacy, King Abdulaziz University, Jeddah, SAU
| | | | | | | |
Collapse
|
7
|
Sokos G, Kido K, Panjrath G, Benton E, Page R, Patel J, Smith PJ, Korous S, Guglin M. Multidisciplinary Care in Heart Failure Services. J Card Fail 2023; 29:943-958. [PMID: 36921886 DOI: 10.1016/j.cardfail.2023.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 03/18/2023]
Abstract
The American College of Cardiology/American Heart Association/Heart Failure Society of American 2022 guidelines for heart failure (HF) recommend a multidisciplinary team approach for patients with HF. The multidisciplinary HF team-based approach decreases the hospitalization rate for HF and health care costs and improves adherence to self-care and the use of guideline-directed medical therapy. This article proposes the optimal multidisciplinary team structure and each team member's delineated role to achieve institutional goals and metrics for HF care. The proposed HF-specific multidisciplinary team comprises cardiologists, surgeons, advanced practice providers, clinical pharmacists, specialty nurses, dieticians, physical therapists, psychologists, social workers, immunologists, and palliative care clinicians. A standardized multidisciplinary HF team-based approach should be incorporated to optimize the structure, minimize the redundancy of clinical responsibilities among team members, and improve clinical outcomes and patient satisfaction in their HF care.
Collapse
Affiliation(s)
- George Sokos
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kazuhiko Kido
- Department of Clinical Pharmacy, West Virginia University School of Pharmacy, Morgantown, West Virginia.
| | - Gurusher Panjrath
- School of Medicine and Health Sciences, George Washington University, North Englewood, Maryland
| | - Emily Benton
- Department of Medicine, University of Colorado, Boulder, Colorado
| | - Robert Page
- Department of Clinical Pharmacy, at the University of Colorado Denver Skaggs School of Pharmacy, Denver, Colorado
| | - Jignesh Patel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Patrick J Smith
- Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Shelly Korous
- Advanced Heart Failure Program, Indiana University Health, Indianapolis, Indiana
| | - Maya Guglin
- Department of Medicine, Indiana University Health, Indianapolis, Indiana
| |
Collapse
|
8
|
Harris M, Moore V, Barnes M, Persha H, Reed J, Zillich A. Effect of pharmacy-led interventions during care transitions on patient hospital readmission: A systematic review. J Am Pharm Assoc (2003) 2022; 62:1477-1498.e8. [PMID: 35718715 DOI: 10.1016/j.japh.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Centers for Medicare and Medicaid (CMS) established the Hospital Readmissions Reduction Program (HRRP) to reduce reimbursement payments to hospitals with excessive patient readmissions. Because of this program, hospitals have developed transitions of care (TOC) programs to improve patient outcomes. OBJECTIVES To identify and uniformly summarize the impact of pharmacy-led TOC interventions on 30-day readmission rates since the implementation of CMS HRRP. METHODS This study followed an a-priori protocol that was registered to International Prospective Register of Systematic Reviews. A systematic search was conducted using PubMed, EMBASE, International Pharmaceutical Abstracts, and CINAHL from January 1, 2013 through January 14, 2022. Studies were included if they met the following criteria: pharmacy-led intervention, 30-day readmission outcomes, patients at least 18 years old, original research performed in the United States, and English language only articles. Descriptive statistics were used to summarize study characteristics, outcomes, and elements of the study interventions. RESULTS A total of 1964 abstracts were screened with 123 studies being included in the review. A total of 110 (89.4%) studies showed a decrease in readmission rates. The largest decrease in readmission rates was 44.5% (range 0.2%-44.5%, median = 7.4%) and the most common pharmacy-led intervention was patient counseling (n = 119, 96.7%) followed by medication reconciliation (n = 111, 90.2%). High-risk patient populations were commonly targeted with 52 studies (42.3%) focusing on CMS HRRP related diagnoses. CONCLUSION Most pharmacist-led TOC interventions contributed to lower rates of 30-day readmission. Future studies should investigate the types of interventions that most significantly impact readmission rates.
Collapse
|
9
|
Lázaro Cebas A, Caro Teller JM, García Muñoz C, González Gómez C, Ferrari Piquero JM, Lumbreras Bermejo C, Romero Garrido JA, Benedí González J. Intervention by a clinical pharmacist carried out at discharge of elderly patients admitted to the internal medicine department: influence on readmissions and costs. BMC Health Serv Res 2022; 22:167. [PMID: 35139838 PMCID: PMC8827191 DOI: 10.1186/s12913-022-07582-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient education on pharmacological treatment could reduce readmissions. Our objective was to carry out a pharmacist intervention focused on providing information about high-risk medications to chronic patients and to analyse its influence on readmissions and costs. METHODS A single-centre study with an intervention group and a retrospective control group was conducted. The intervention was carried out in all polymedicated patients ≥ 65 years who were admitted to internal medicine and signed the informed consent between June 2017 and February 2018. Patients discharged to nursing homes or long-term hospitals were excluded. The control group were all the patients who were admitted during the same months of 2014 who met the same inclusion criteria. The patients were classified according to the HOSPITAL score as having a low, intermediate, or high risk of potentially avoidable readmission. Outcome measures were 30-day readmission and cost data. To analyse the effect of the intervention on readmission, a logistic regression was performed. RESULTS The study included 589 patients (286 intervention group; 303 control group). The readmission rate decreased from 20.13% to 16.43% in the intervention group [OR = 0.760 95% CI (0.495-1.166); p = 0.209)]. The incremental cost for the intervention to prevent one readmission was €3,091.19, and the net cost saving was €1,301.26. In the intermediate- and high-risk groups, readmissions were reduced 10.91% and 10.00%, and the net cost savings were €3,3143.15 and €3,248.71, respectively. CONCLUSIONS The pharmacist intervention achieved savings in the number of readmissions, and the net cost savings were greater in patients with intermediate and high risks of potentially avoidable readmission according to the HOSPITAL score.
Collapse
Affiliation(s)
- Andrea Lázaro Cebas
- Pharmacy Management Department. Dirección General de Asistencia Sanitaria, Servicio Murciano de Salud, Murcia, Spain.
| | | | | | | | | | | | - José Antonio Romero Garrido
- Pharmacy Department Hospital, Universitario La Paz, Madrid, Spain.,Pharmacology Department. Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Juana Benedí González
- Pharmacology Department. Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| |
Collapse
|
10
|
Amin AN, Cornelison S, Woods JA, Hanania NA. Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team. Postgrad Med 2021; 134:152-159. [PMID: 34913814 DOI: 10.1080/00325481.2021.2018257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with high rates of hospitalizations, costs, and morbidity. Therefore, hospitalists and the multidisciplinary team (hospital team) need to take a proactive approach to ensure patients are effectively managed from hospital admission to postdischarge. Comprehensive screening and diagnostic testing of patients at admission will enable an accurate diagnosis of COPD exacerbations, and severity, as well as other factors that may impact the length of hospital stay. Depending on the exacerbation severity and cause, pharmacotherapies may include short-acting bronchodilators, systemic corticosteroids, and antibiotics. Oxygen and/or ventilatory support may benefit patients with demonstrable hypoxemia. In preparation for discharge, the hospital team should ensure that patients receive the appropriate maintenance therapy, are counseled on their medications including inhalation devices, and proactively discuss smoking cessation and vaccinations. For follow-up, effective communication can be achieved by transferring discharge summaries to the primary care physician via an inpatient case manager. An inpatient case manager can support both the hospitalist and the patient in scheduling follow-up appointments, sending patient reminders, and confirming that a first outpatient visit has occurred. A PubMed search (prior to 26 January 2021) was conducted using terms such as: COPD, exacerbation, hospitalization. This narrative review focuses on the challenges the hospital team encounters in achieving optimal outcomes in the management of patients with COPD exacerbations. Additionally, we propose a novel simplified algorithm that may help the hospital team to be more proactive in the diagnosis and management of patients with COPD exacerbations.
Collapse
Affiliation(s)
- Alpesh N Amin
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Sharon Cornelison
- Department of Pulmonary and Cardiac Rehabilitation, J. Paul Sticht Center on Aging and Rehabilitation, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC, USA
| | - J Andrew Woods
- Wingate University School of Pharmacy, and Atrium Health, Carolinas Medical Center Main, Charlotte, NC, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
11
|
Impact of pharmacist and physician collaborations in primary care on reducing readmission to hospital: A systematic review and meta-analysis. Res Social Adm Pharm 2021; 18:2922-2943. [PMID: 34303610 DOI: 10.1016/j.sapharm.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Readmissions to hospital due to medication-related problems are common and may be preventable. Pharmacists act to optimise use of medicines during care transitions from hospital to community. OBJECTIVE To assess the impact of pharmacist-led interventions, which include communication with a primary care physician (PCP) on reducing hospital readmissions. METHODS PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science were searched for articles published from inception to March 2021 that described interventions involving a pharmacist interacting with a PCP in regards to medication management of patients recently discharged from hospital. The primary outcome was effect on all-cause readmission expressed as Mantel-Haenszel risk ratio (RR) derived from applying a random effects model to pooled data. Sensitivity analysis was also conducted to investigate differences between randomised controlled trials (RCTs) and non-RCTs. The GRADE system was applied in rating the quality of evidence and certainty in the estimates of effect. RESULTS In total, 37 studies were included (16 RCTs and 29 non-RCTs). Compared to control patients, the proportion of intervention patients readmitted at least once was significantly reduced by 13% (RR = 0.87, CI:0.79-0.97, p = 0.01; low to very low certainty of evidence) over follow-up periods of variable duration in all studies combined, and by 22% (RR = 0.78, CI:0.67-0.92; low certainty of evidence) at 30 day follow-up across studies reporting this time point. Analysis of data from RCTs only showed no significant reduction in readmissions (RR = 0.92, CI:0.80-1.06; low certainty of evidence). CONCLUSIONS The totality of evidence suggests pharmacist-led interventions with PCP communication are effective in reducing readmissions, especially at 30 days follow-up. Future studies need to adopt more rigorous study designs and apply well-defined patient eligibility criteria.
Collapse
|
12
|
King PK, Burkhardt C, Rafferty A, Wooster J, Walkerly A, Thurber K, Took R, Masterson J, St. Peter WL, Furuno JP, Williams E, Ferren J, Rascon K. Quality measures of clinical pharmacy services during transitions of care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Roxane Took
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | - Jon P. Furuno
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Evan Williams
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Janie Ferren
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | |
Collapse
|
13
|
Martirosov AL, Smith ZR, Hencken L, MacDonald NC, Griebe K, Fantuz P, Grafton G, Hegab S, Ismail R, Jackson B, Kelly B, Miller M, Awdish R. Improving transitions of care for critically ill adult patients on pulmonary arterial hypertension medications. Am J Health Syst Pharm 2021; 77:958-965. [PMID: 32495842 DOI: 10.1093/ajhp/zxaa079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The purpose of this report is to describe the activities of critical care and ambulatory care pharmacists in a multidisciplinary transitions-of-care (TOC) service for critically ill patients with pulmonary arterial hypertension (PAH) receiving PAH medications. SUMMARY Initiation of medications for treatment of PAH involves complex medication access steps. In the ambulatory care setting, multidisciplinary teams often have a process for completing these steps to ensure access to PAH medications. Patients with PAH are frequently admitted to an intensive care unit (ICU), and their home PAH medications are continued and/or new medications are initiated in the ICU setting. Inpatient multidisciplinary teams are often unfamiliar with the medication access steps unique to PAH medications. The coordination and completion of medication access steps in the inpatient setting is critical to ensure access to medications at discharge and prevent delays in care. A PAH-specific TOC bundle for patients prescribed a PAH medication who are admitted to the ICU was developed by a multidisciplinary team at an academic teaching hospital. The service involves a critical care pharmacist completing a PAH medication history, assessing for PAH medication access barriers, and referring patients to an ambulatory care pharmacist for postdischarge telephone follow-up. In collaboration with the PAH multidisciplinary team, a standardized workflow to be initiated by the critical care pharmacist was developed to streamline completion of PAH medication access steps. Within 3 days of hospital discharge, the ambulatory care pharmacist calls referred patients to ensure access to PAH medications, provide disease state and medication education, and request that the patient schedule a follow-up office visit to take place within 14 days of discharge. CONCLUSION Collaboration by a PAH multidisciplinary team, critical care pharmacist, and ambulatory care pharmacist can improve TOC related to PAH medication access for patients with PAH. The PAH TOC bundle serves as a model that may be transferable to other health centers.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Sara Hegab
- Henry Ford Hospital, Detroit, MI, and Wayne State University School of Medicine, Detroit, MI
| | | | | | | | | | - Rana Awdish
- Henry Ford Hospital, Detroit, MI, and Wayne State University School of Medicine, Detroit, MI
| |
Collapse
|
14
|
Du RY, Shelton G, Ledet CR, Mills WL, Neal-Herman L, Horstman M, Trautner B, Awad S, Berger D, Naik AD. Implementation and Feasibility of the Re-Engineered Discharge for Surgery (RED-S) Intervention: A Pilot Study. J Healthc Qual 2021; 43:92-100. [PMID: 32544139 PMCID: PMC9825132 DOI: 10.1097/jhq.0000000000000266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Adapting Project Re-Engineered Discharge (Project RED), an intervention for reducing internal medicine hospital readmissions, is a promising option for reducing colorectal surgery readmissions. METHODS We conducted a pilot study for the adaptation and implementation of Project RED with patients admitted for colectomy at a regional VA tertiary care center between July 2014 and January 2015. Implementation was evaluated using adherence to intervention components and results from the Survey of Healthcare Experiences of Patients. The adapted Project RED for Surgery has five components: surgical wound/ostomy-care education, scheduled follow-up appointments, medication reconciliation, an After Hospital Care Plan, and postdischarge phone calls. RESULTS All (n = 21) participants received postoperative wound care education, and 77% of ostomy patients received education. Follow-up appointments were scheduled for 76% with surgery clinic and 67% with primary care. Half received pharmacist-led medication reconciliation. Seventy-five percent received a postdischarge phone call. Ninety five percent of participants reported positive or satisfactory care transitions versus less than 60% of a comparison group of surgery patients from the same institution. We summarized lessons learned from this intervention study to facilitate future dissemination efforts. CONCLUSION The lessons learned from this pilot can guide quality improvement teams seeking to implement the Re-Engineered Discharge for Surgery intervention within their existing workflows.
Collapse
|
15
|
Benjenk I, DuGoff EH, Jacobsohn GC, Cayenne N, Jones CMC, Caprio TV, Cushman JT, Green RK, Kind AJH, Lohmeier M, Mi R, Shah MN. Predictors of Older Adult Adherence With Emergency Department Discharge Instructions. Acad Emerg Med 2021; 28:215-225. [PMID: 32767696 DOI: 10.1111/acem.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. METHODS We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention). RESULTS A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. CONCLUSION Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.
Collapse
Affiliation(s)
- Ivy Benjenk
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
| | - Eva H. DuGoff
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- the Berkeley Research Group Washington DCUSA
| | - Gwen C. Jacobsohn
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Nia Cayenne
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Courtney M. C. Jones
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
| | - Thomas V. Caprio
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Medicine Division of Geriatrics University of Rochester Medical Center Rochester NYUSA
| | - Jeremy T. Cushman
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
| | - Rebecca K. Green
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Amy J. H. Kind
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- and the William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center Madison WIUSA
| | - Michael Lohmeier
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Ranran Mi
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Manish N. Shah
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| |
Collapse
|
16
|
Lai L, Alvarez G, Aleu A, Apping C. Cost Avoidance Analysis of Medication Conversions on the Treatment of Gastroesophageal Reflux Disease in a Medication Therapy Management Call Center: A Budgetary Perspective. J Pharm Pract 2020; 35:377-382. [PMID: 33317384 DOI: 10.1177/0897190020977764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The burden of prescription drug prices affects patients and health system, creating a need for pharmacists to use their medication expertise to recommend the most cost-effective treatment for patients. OBJECTIVE The study aimed to analyze the cost avoidance for medication conversions related to GERD from an integrated medication therapy management call center. METHODS A quasi-experimental study was conducted at a call center during a 12-month intervention. Adult patients aged ≥18 years who received highercost PPIs were included. The pharmacists provided MTM services to patients telephonically to review all aspects of the patients' medication regimen as well as conversion recommendation to lower-cost PPIs. The cost avoidance analysis and sensitivity analysis were conducted. RESULTS Of 40 eligible patients, 9 patients accepted the medication conversion, resulting in a 22.5% acceptance rate. The total cost avoidance from medication conversions was $19,937.1 per year, which equated to $2,215.2 per patient. The adjusted cost avoidance of medication conversion was estimated by assuming the patients who accepted the conversion continued taking the medication for 365 days and resulted in a total savings of $40,370.7 per year, which equated to $4,485.6 per patient. There were no significant association between the acceptance of medication conversions and patient's age(P = 0.15), gender(P = 0.73), and insurance status(P = 0.96). CONCLUSION The study results showed that the call-center MTM with medicationconversion interventions successfully demonstrated an economically advantageous impact from a budgetary perspective. Further studies should explore methods to increase acceptance of MTM services and promote awareness of the profound effect on public health and well-being.
Collapse
Affiliation(s)
- Leanne Lai
- College of Pharmacy, 69279Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Goar Alvarez
- College of Pharmacy, 69279Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Aisy Aleu
- College of Pharmacy, 69279Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Caitlan Apping
- College of Pharmacy, 69279Nova Southeastern University, Ft. Lauderdale, FL, USA
| |
Collapse
|
17
|
Odeh M, Scullin C, Hogg A, Fleming G, Scott MG, McElnay JC. A novel approach to medicines optimisation post-discharge from hospital: pharmacist-led medicines optimisation clinic. Int J Clin Pharm 2020; 42:1036-1049. [PMID: 32524511 PMCID: PMC7476989 DOI: 10.1007/s11096-020-01059-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/11/2020] [Indexed: 11/11/2022]
Abstract
Background There is a major drive within healthcare to reduce patient readmissions, from patient care and cost perspectives. Pharmacist-led innovations have been demonstrated to enhance patient outcomes. Objective To assess the impact of a post-discharge, pharmacist-led medicines optimisation clinic on readmission parameters. Assessment of the economic, clinical and humanistic outcomes were considered. Setting Respiratory and cardiology wards in a district general hospital in Northern Ireland. Method Randomised, controlled trial. Blinded random sequence generation; a closed envelope-based system, with block randomisation. Adult patients with acute unplanned admission to medical wards subject to inclusion criteria were invited to attend clinic. Analysis was carried out for intention-to-treat and per-protocol perspectives. Main Outcome Measure 30-day readmission rate. Results Readmission rate reduction at 30 days was 9.6% (P = 0.42) and the reduction in multiple readmissions over 180-days was 29.1% (P = 0.003) for the intention-to-treat group (n = 31) compared to the control group (n = 31). Incidence rate ratio for control patients for emergency department visits was 1.65 (95% CI 1.05-2.57, P = 0.029) compared with the intention-to-treat group. For unplanned GP consultations the equivalent incident rate ratio was 2.00 (95% CI 1.18-3.58, P = 0.02). Benefit to cost ratio in the intention-to-treat and per-protocol groups was 20.72 and 21.85 respectively. Patient Health Related Quality of Life was significantly higher at 30-day (P < 0.001), 90-day (P < 0.001) and 180-day (P = 0.036) time points. A positive impact was also demonstrated in relation to patient beliefs about their medicines and medication adherence. Conclusion A pharmacist-led post-discharge medicines optimisation clinic was beneficial from a patient care and cost perspective.
Collapse
Affiliation(s)
- Mohanad Odeh
- Pharmacy Management and Pharmaceutical Care Innovation Centre, Hashemite University, 13133 Hashemite University, Zarqa, Jordan
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - Anita Hogg
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - Michael G Scott
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| |
Collapse
|
18
|
Mayzel B, Axtell S, Richardson C, Link N. The Impact of Face-to-Face Pharmacist Transitional Care Management Visits on Medication-Related Problems. J Pharm Technol 2020; 36:95-101. [PMID: 37927305 PMCID: PMC10621677 DOI: 10.1177/8755122520905582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background: Studies are needed to evaluate medication-related problems (MRPs) to assess the effect of a pharmacist on managing medications postdischarge. Objective: To assess the ability of pharmacist-led medication review and reconciliation to reduce the number of MRPs found in transitional care medicine (TCM) visits, leading to medication optimization. Methods: This study involved a retrospective chart review of standard TCM procedure at a family/internal medicine clinic and a prospective, team-based TCM visit in the same clinic. Inclusion criteria included patients discharged from any hospital within our institution and seen in the clinic. The primary outcome was the difference in the proportion of MRPs found between the prospective and retrospective groups. Secondary outcomes included the number and specific type of MRPs found, classified by the Pharmaceutical Care Network Europe tool, and further subdivided by patient aware or unaware of MRP, only in the prospective group, as well as 30-day readmission rate. Results: Patients in the prospective group (n = 50) had an average age of 67.9 years versus 65.5 years in the retrospective group (n = 50). Four times as many patients in the prospective group were found to have MRPs than the retrospective group. The most common MRP was due to a patient-related factor, meaning the cause is related to a patient's behavior. Patients were unaware of the MRP in a majority of these cases. Thirty-day readmission rate did not differ between the groups. Conclusion: Team-based TCM visits that included a pharmacist-led medication reconciliation uncovered more MRPs than patients who did not have a pharmacist perform a medication reconciliation.
Collapse
Affiliation(s)
- Bianca Mayzel
- Cleveland Clinic—Hillcrest Hospital, Mayfield, OH, USA
| | - Sandra Axtell
- Cleveland Clinic—Hillcrest Hospital, Mayfield, OH, USA
| | | | - Nicholas Link
- Cleveland Clinic—Hillcrest Hospital, Mayfield, OH, USA
| |
Collapse
|
19
|
Nijhawan AE, Higashi RT, Marks EG, Tiruneh YM, Lee SC. Patient and Provider Perspectives on 30-Day Readmissions, Preventability, and Strategies for Improving Transitions of Care for Patients with HIV at a Safety Net Hospital. J Int Assoc Provid AIDS Care 2020; 18:2325958219827615. [PMID: 30760091 PMCID: PMC6748499 DOI: 10.1177/2325958219827615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thirty-day hospital readmissions, a key quality metric, are common among people living with HIV. We assessed perceived causes of 30-day readmissions, factors associated with preventability, and strategies to reduce preventable readmissions and improve continuity of care for HIV-positive individuals. Patient, provider, and staff perspectives toward 30-day readmissions were evaluated in semistructured interviews (n = 86) conducted in triads (HIV-positive patient, medical provider, and case manager) recruited from an inpatient safety net hospital. Iterative analysis included both deductive and inductive themes. Key findings include the following: (1) The 30-day metric should be adjusted for safety net institutions and patients with AIDS; (2) Participants disagreed about preventability, especially regarding patient-level factors; (3) Various stakeholders proposed readmission reduction strategies that spanned the inpatient to outpatient care continuum. Based on these diverse perspectives, we outline multiple interventions, from teach-back patient education to postdischarge home visits, which could substantially decrease hospital readmissions in this underserved population.
Collapse
Affiliation(s)
- Ank E Nijhawan
- 1 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,3 Parkland Health & Hospital System, Dallas, TX, USA
| | - Robin T Higashi
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily G Marks
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yordanos M Tiruneh
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,4 Department of Community Health, University of Texas Health Science Center, Tyler, TX, USA
| | - Simon Craddock Lee
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
20
|
McFarland MS, Thomas AM, Young E, Bryant C, Hughes JC, Hoffman J, Baker JW. Implementation and Effect of a Pharmacist-to-Pharmacist Transitions of Care Initiative on Ambulatory Care Sensitive Conditions. J Manag Care Spec Pharm 2020; 26:513-519. [PMID: 32223605 PMCID: PMC10391248 DOI: 10.18553/jmcp.2020.26.4.513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND One of the most vulnerable times in a patient's encounter with a health care system is during transitions of care (TOC), defined by the Joint Commission as the movement of a patient from one health care provider or setting to another. The use of a clinical pharmacist as a member of the care transitions team has received focused attention and shown improved benefit. OBJECTIVE To determine the effect of a large-scale pharmacist-to-pharmacist TOC model where inpatient clinical pharmacists identify patients during a hospital stay, provide evidence-based care and education, and then coordinate follow-up with an outpatient clinical pharmacist who provided comprehensive medication management (CMM) under a scope of practice. METHODS This was a multisite, single health care system, quasi-experimental, matched interrupted time series design study conducted at an integrated Veterans Affairs (VA) health care system. Patients admitted with a primary or secondary diagnosis of diabetes, hypertension, chronic obstructive pulmonary disease (COPD) and heart failure (HF) were included for enrollment. Clinical pharmacists rounding on inpatient medical teams provided evidence-based recommendations to optimize medications while coordinating follow-up by an outpatient clinical pharmacy specialist within 10 days of discharge for CMM. The primary endpoint of this study was to determine the effect on the composite all-cause 30-day acute care utilization rate (emergency department [ED] visit or hospital readmission) for patients discharged with a primary or secondary diagnosis of diabetes, hypertension, COPD, and HF compared with a comparator group of patients with similar discharge diagnosis before implementation of the TOC program. RESULTS 484 patients (242 in each group, with 366 heart failure, 66 COPD, 10 hypertension, and 42 diabetes) were included for analysis. For the primary outcome of composite 30-day, all-cause acute care utilization rates, no statistically significant difference was identified, with 26.9% of patients in the intervention group and 28.9% in the historical group readmitted or seen in the ED within 30 days of discharge (P = 0.6852). Outcomes for the HF index acute care utilization rate (i.e., admission for the same disease state discharged with), including 30-day index readmissions (P = 0.0014), 30-day index ED visits (P = 0.0047), and 90-day index readmissions for HF (P < 0.0001) were significantly reduced. CONCLUSIONS Our study is one of the first to identify at-risk patients using rounding clinical pharmacists in the acute care arena and coordination of care systematically with a clinical pharmacy specialist practicing under a scope of practice targeted for CMM. Although the overall primary endpoint was not met, a reduction in acute care utilization rates for HF at 30 and 90 days can be achieved. DISCLOSURES No outside funding supported this research. The authors report no conflicts of interest.
Collapse
Affiliation(s)
- M Shawn McFarland
- Clinical Practice Integration and Model Advancement, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, Veterans Health Administration, Washington, DC
| | | | - Emily Young
- Tennessee Valley Healthcare System, Nashville
| | | | | | - Joy Hoffman
- Northeast Ohio VA Healthcare System, Cleveland
| | | |
Collapse
|
21
|
Stranges PM, Jackevicius CA, Anderson SL, Bondi DS, Danelich I, Emmons RP, Englin EF, Hansen ML, Nys C, Phan H, Philbrick AM, Rager M, Schumacher C, Smithgall S. Role of clinical pharmacists and pharmacy support personnel in transitions of care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - Ilya Danelich
- American College of Clinical Pharmacy; Lenexa Kansas
| | | | | | | | - Cara Nys
- American College of Clinical Pharmacy; Lenexa Kansas
| | - Hanna Phan
- American College of Clinical Pharmacy; Lenexa Kansas
| | | | | | | | | |
Collapse
|
22
|
Improvement in the medication reconciliation postdischarge quality measure after implementation of a pharmacist-run service. J Am Pharm Assoc (2003) 2020; 60:391-396. [DOI: 10.1016/j.japh.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 11/23/2022]
|
23
|
Bethishou L, Herzik K, Fang N, Abdo C, Tomaszewski DM. The impact of the pharmacist on continuity of care during transitions of care: A systematic review. J Am Pharm Assoc (2003) 2020; 60:163-177.e2. [DOI: 10.1016/j.japh.2019.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/31/2019] [Accepted: 06/26/2019] [Indexed: 12/01/2022]
|
24
|
McPhail EJ, Marshall VD, Remington TL, Vordenberg SE. Readmission Rates Associated with Pharmacist Involvement in a Geriatric Transitional Care Management Clinic. Innov Pharm 2019; 10. [PMID: 34007564 PMCID: PMC8127088 DOI: 10.24926/iip.v10i3.2211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the impact of a post-discharge pharmacist telephone call on 30- and 90- day readmission rates as part of a transitional care management (TCM) service in a geriatric patient-centered medical home (PCMH). Methods: Adults 60 years of age and older who had established primary care at the PCMH for at least one year and were discharged from the hospital between 7/1/2013 and 2/21/2016 were included. Readmission rates for patients who received and did not receive a pharmacist TCM phone call were compared. Secondary data analysis was conducted between individuals who received all three components of the service compared with those who received on a nurse navigator plus primary care provider (PCP) visit. Results: Among 513 discharges of unique patients (mean age, 80.4 years; women 63%), 269 (52.4%) received a pharmacist phone call. Readmission rates at 30 days were 8.9% for patients who received a pharmacist TCM phone call compared to 12.7% for those who did not receive this service (OR 0.67 [95% CI, 0.38-1.18; P=0.17]). When comparing only those individuals who received all three components of the service (pharmacist, nurse navigator, and PCP) (n=215) compared to those who received only a nurse navigator plus PCP visit (n=66), there was no difference in 30-day readmission rates (7.9% vs. 10.6%, p=0.49). However, there were significantly fewer readmissions within 90-days (16.3% vs. 31.8%, p=0.01). Conclusion: Pharmacist phone calls as part of an interdisciplinary TCM service did not result in a statistically significant difference regarding readmission rates at 30 days; however, patients who received all three components of the service had significantly fewer readmissions at 90 days, compared to patients who did not speak with a pharmacist but did complete a visit with a nurse navigator and physician. Future research is needed to determine which patients may benefit the most from this service and to identify strategies to increase patient participation.
Collapse
|
25
|
Eldeib HK, Abbassi MM, Hussein MM, Salem SE, Sabry NA. The Effect of Telephone-Based Follow-Up on Adherence, Efficacy, and Toxicity of Oral Capecitabine-Based Chemotherapy. Telemed J E Health 2019; 25:462-470. [DOI: 10.1089/tmj.2018.0077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hend K. Eldeib
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Maggie M. Abbassi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Marwa M. Hussein
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Salem E. Salem
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nirmeen A. Sabry
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| |
Collapse
|
26
|
Swarthout M, Bishop MA. Population health management: Review of concepts and definitions. Am J Health Syst Pharm 2019; 74:1405-1411. [PMID: 28887342 DOI: 10.2146/ajhp170025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The terms population health, population health improvement, and population health management are discussed. SUMMARY A key concept in defining population health activities is clearly delineating the population(s) of focus. The Institute for Healthcare Improvement's (IHI's) Triple Aim Initiative uses the term population health management to describe the work by healthcare organizations to improve outcomes for individual patients to maximize population health. The National Academy of Medicine favors the term population health improvement and uses this term to describe work to identify and improve aspects of or contributors to population health, expanding the focus beyond traditional healthcare delivery systems. As organizations like IHI and the National Academy of Medicine continue to focus on population health, the terms and definitions used to describe these activities will continue to evolve. CONCLUSION The use of consistent, clear definitions for population health activities is critical to the practice of pharmacy and healthcare delivery.
Collapse
Affiliation(s)
- Meghan Swarthout
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD .,Johns Hopkins Outpatient Pharmacy, Baltimore, MD.
| | - Martin A Bishop
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD
| |
Collapse
|
27
|
Odeh M, Scullin C, Fleming G, Scott MG, Horne R, McElnay JC. Ensuring continuity of patient care across the healthcare interface: Telephone follow-up post-hospitalization. Br J Clin Pharmacol 2019; 85:616-625. [PMID: 30675742 DOI: 10.1111/bcp.13839] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 01/14/2023] Open
Abstract
AIMS To implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group. METHOD Pragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service. RESULTS Using an intention to treat approach, reductions in 30- and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio = 0.57; 95% confidence interval (CI): 0.36-0.90; P < 0.001] and 15.2% (odds ratio = 0.53; 95% CI: 0.36-0.79; P = 0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9-74.9) for intervention group compared with 60.1 days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs. 6.7 days; P < 0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to -2.27; P < 0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P < 0.001). Most patients (83.8%) reported having better control of their medicines after the intervention. CONCLUSIONS Pharmacist-led postdischarge structured TFU intervention can reduce 30- and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction.
Collapse
Affiliation(s)
- Mohanad Odeh
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.,Faculty of Pharmaceutical Sciences, Hashemite University, Jordan
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | | | - Robert Horne
- School of Pharmacy, University College London, London, WC1N 1AX, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
| |
Collapse
|
28
|
Impact of a community pharmacy transitions-of-care program on 30-day readmission. J Am Pharm Assoc (2003) 2018; 59:202-209. [PMID: 30552052 DOI: 10.1016/j.japh.2018.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/01/2018] [Accepted: 10/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The primary objective of this study was to evaluate the impact of a transitions-of-care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmissions. DESIGN, SETTING, AND PARTICIPANTS A TOC program in an outpatient pharmacy, driven primarily by student pharmacists, provided telephone-based counseling to recently discharged patients. The calls were conducted within 2 to 7 days after discharge and focused on medication counseling and reconciliation, as well as promotion of a physician follow-up visit. The goal of this program was to decrease hospital readmissions among patients discharged with a cardiovascular-related diagnosis. Patient-specific information was recorded in a spreadsheet, including discharge diagnosis, and readmission diagnosis for those who returned to an inpatient facility within 30 days. This study was a retrospective chart review. Data were manually extracted from the program's data spreadsheet and the institution's electronic medical record for patients referred to the TOC program from June through November 2017. Patients discharged to hospice, prison, or a long-term care facility were excluded from analysis. Researchers collected information on patient demographics, diagnoses, and readmissions. Data analyses were performed with the use of SAS 9.4. OUTCOME MEASURES The primary outcome measure was 30-day all-cause readmission, and the secondary measure was 30-day related readmission. RESULTS A total of 1219 encounters were examined. Compared with those patients without TOC participation, those who used the TOC program had a 67% decreased odds of all-cause 30-day readmission (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.22-0.48; P < 0.0001) and a 62% decreased odds of a related readmission (OR 0.38, 95% CI 0.18-0.82; P = 0.008). CONCLUSION Community pharmacists and Advanced Pharmacy Practice Experience-level student pharmacists have the potential to make a significant impact on reducing hospital readmission rates.
Collapse
|
29
|
Nguyen PA(A, Enwere E, Gautreaux S, Lin H, Tverdek F, Lu M, Cao H, Chase J, Roux R. Impact of a pharmacy-driven transitions-of-care program on postdischarge healthcare utilization at a national comprehensive cancer center. Am J Health Syst Pharm 2018; 75:1386-1393. [DOI: 10.2146/ajhp170747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Emmanuel Enwere
- Division of Oncology Care & Research IS, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stefani Gautreaux
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heather Lin
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frank Tverdek
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maggie Lu
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Henry Cao
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Judy Chase
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ryan Roux
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
30
|
Nguyen V, Sarik DA, Dejos MC, Hilmas E. Development of an Interprofessional Pharmacist-Nurse Navigation Pediatric Discharge Program. J Pediatr Pharmacol Ther 2018; 23:320-328. [PMID: 30181724 DOI: 10.5863/1551-6776-23.4.320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Numerous challenges face clinically complex patients as they transition from hospital to home. The purpose of this project was to add pharmacy discharge services to an existing nurse-led discharge service (patient navigation program) to facilitate the transition of care process for clinically complex pediatric patients. METHODS For select patients referred to the service, a pharmacist resolved medication discrepancies, provided discharge counseling, and conducted follow-up telephone encounters on days 1, 7, and 14 post discharge. Patient demographics, admitting diagnosis, and number of discharge medications were recorded. The impact on patient outcomes was measured by the number and type of pharmacist interventions identified. Program utilization was measured by the number of referrals received, percentage of patients seen by a pharmacist, follow-up phone call completion rate, and pharmacist time required. Financial benefit gained from the program was estimated by translating each pharmaceutical intervention into potential cost savings. RESULTS There were 321 patient navigation referrals during the 5 months of pharmacist service. A pharmacist was able to provide discharge counseling for 56 discharges (17%). Patients who were provided pharmacy services had a median of 8 comorbidities, 10-day length of stay, and 4 discharge medications. Pharmacists identified 168 interventions, of which 93.5% were accepted or informational in nature. The most frequently identified interventions included clarification of drug order, assistance obtaining medication, and dose rounding. This program resulted in an estimated cost savings of $22,308 in the first 5 months. CONCLUSIONS A unique partnership between nurses and pharmacists facilitated the discharge process for clinically complex children.
Collapse
|
31
|
Lacy MC, Bryant GA, Herring MS, Koenigsfeld CF, Lehman NP, Smith HL. Implementation and evaluation of a pharmacy-driven transitions of care program for patients discharged from the emergency department. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mary C. Lacy
- Presence Saint Joseph Hospital; Chicago Illinois
| | - Ginelle A. Bryant
- Department of Clinical Sciences; Drake University College of Pharmacy and Health Sciences; Des Moines Iowa
| | - Morgan S. Herring
- Department of Pharmacy Practice and Science/Division of Applied Clinical Sciences; University of Iowa College of Pharmacy; Iowa City Iowa
| | - Carrie F. Koenigsfeld
- Department of Clinical Sciences; Drake University College of Pharmacy and Health Sciences; Des Moines Iowa
| | - Nicholas P. Lehman
- Department of Clinical Sciences; Drake University College of Pharmacy and Health Sciences; Des Moines Iowa
| | - Hayden L. Smith
- Medical Education; Iowa Methodist Medical Center; Des Moines Iowa
- Internal Medicine; University of Iowa Carver College of Medicine; Iowa City Iowa
| |
Collapse
|
32
|
Boylan PM, Eltaki SM. Post-graduate year two transitions of care pharmacy residencies no longer accredited. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:543-545. [PMID: 29986811 DOI: 10.1016/j.cptl.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/13/2017] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Literature supports pharmacist integration within transitions of care. A total of eight health-system pharmacies and colleges of pharmacy developed focused post-graduate year two (PGY2) training in this specialty. However, in fall 2016, ongoing accreditation of these PGY2 transitions of care programs was discontinued by the American Society of Health-System Pharmacists Commission on Credentialing. PERSPECTIVE Healthcare relies on interprofessional collaborations and corresponding programs in order to improve patient care. Pharmacists who have completed specialized training in transitions of care are not only leaders in this realm but also ambassadors for interprofessional medicine. IMPLICATIONS Rebranding transitions of care PGY2 programs fails to capture all the opportunities available to train and mentor new transitions of care pharmacists. Lack of consensual accreditation introduces variability within training. There may be opportunities to revisit transitions of care PGY2 accreditation in the future.
Collapse
Affiliation(s)
- Paul M Boylan
- Assistant Professor, Larkin University College of Pharmacy, 18301 North Miami Avenue, Miami, FL, United States.
| | - Sara M Eltaki
- Clinical Coordinator - Transitions of Care, Memorial Regional Hospital, 3501 Johnson Street, Hollywood, FL, United States.
| |
Collapse
|
33
|
Robertson FC, Logsdon JL, Dasenbrock HH, Yan SC, Raftery SM, Smith TR, Gormley WB. Transitional care services: a quality and safety process improvement program in neurosurgery. J Neurosurg 2018; 128:1570-1577. [DOI: 10.3171/2017.2.jns161770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEReadmissions increasingly serve as a metric of hospital performance, inviting quality improvement initiatives in both medicine and surgery. However, few readmission reduction programs have targeted surgical patient populations. The objective of this study was to establish a transitional care program (TCP) with the goal of decreasing length of stay (LOS), improving discharge efficiency, and reducing readmissions of neurosurgical patients by optimizing patient education and postdischarge surveillance.METHODSPatients undergoing elective cranial or spinal neurosurgery performed by one of 5 participating surgeons at a quaternary care hospital were enrolled into a multifaceted intervention. A preadmission overview and establishment of an anticipated discharge date were both intended to set patient expectations for a shorter hospitalization. At discharge, in-hospital prescription filling was provided to facilitate medication compliance. Extended discharge appointments with a neurosurgery TCP-trained nurse emphasized postoperative activity, medications, incisional care, nutrition, signs that merit return to medical attention, and follow-up appointments. Finally, patients received a surveillance phone call 48 hours after discharge. Eligible patients omitted due to staff limitations were selected as controls. Patients were matched by sex, age, and operation type—key confounding variables—with control patients, who were eligible patients treated at the same time period but not enrolled in the TCP due to staff limitation. Multivariable logistic regression evaluated the association of TCP enrollment with discharge time and readmission, and linear regression with LOS. Covariates included matching criteria and Charlson Comorbidity Index scores.RESULTSBetween 2013 and 2015, 416 patients were enrolled in the program and matched to a control. The median patient age was 55 years (interquartile range 44.5–65 years); 58.4% were male. The majority of enrolled patients underwent spine surgery (59.4%, compared with 40.6% undergoing cranial surgery). Hospitalizations averaged 62.1 hours for TCP patients versus 79.6 hours for controls (a 16.40% reduction, 95% CI 9.30%–23.49%; p < 0.001). The intervention was associated with a higher proportion of morning discharges, which was intended to free beds for afternoon admissions and improve patient flow (OR 3.13, 95% CI 2.27–4.30; p < 0.001), and decreased 30-day readmissions (2.5% vs 5.8%; OR 2.43, 95% CI 1.14–5.27; p = 0.02).CONCLUSIONSThis neurosurgical TCP was associated with a significantly shorter LOS, earlier discharge, and reduced 30-day readmission after elective neurosurgery. These results underscore the importance of patient education and surveillance after hospital discharge.
Collapse
Affiliation(s)
| | - Jessica L. Logsdon
- 2Cushing Neurosurgical Outcomes Center,
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Hormuzdiyar H. Dasenbrock
- 1Harvard Medical School; and
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sandra C. Yan
- 2Cushing Neurosurgical Outcomes Center,
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Siobhan M. Raftery
- 2Cushing Neurosurgical Outcomes Center,
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Timothy R. Smith
- 1Harvard Medical School; and
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - William B. Gormley
- 1Harvard Medical School; and
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
34
|
Bach QN, Peasah SK, Barber E. Review of the Role of the Pharmacist in Reducing Hospital Readmissions. J Pharm Pract 2018; 32:617-624. [DOI: 10.1177/0897190018765500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital readmissions remain a public health concern despite progress in reducing and preventing its occurrence. Among strategies that have been implemented to reduce readmission most involves medication management. Our objective was to evaluate the effectiveness of interventions involving pharmacists to reduce hospital readmissions. PubMed and Google Scholar were searched for primary literature from January 1990 to July 2016 with search terms such as “hospital readmission,” and “Pharmacist,” or “Pharmacy,” or “medications.” Studies with an abstract in English which highlighted a pharmacist involvement based on the type of intervention, country of origin, type of study, and findings were summarized. The outcomes of these interventions to reduce hospital readmissions were mixed. Of the 29 studies, 16 (55%) showed a statistically significant reduction in readmissions ranging from 3.3% to 30%. Most of the interventions focused mainly on patient education postdischarge (8) or in addition to medication reconciliation predischarge (9). There were no studies from Africa or Asia but mainly from the United States (72%). Although multiple factors contribute to hospital readmission, this review highlights the important role pharmacists can play singularly and as part of interdisciplinary teams. Most effective interventions often involved medication review and patient education postdischarge.
Collapse
Affiliation(s)
- Quyen N. Bach
- Phoebe Putney Memorial Hospital, Mercer College of Pharmacy, Mercer University, Atlanta, GA, USA
| | - Samuel K. Peasah
- Center for Clinical Outcomes Research and Education (CCORE), Mercer College of Pharmacy, Mercer University, Atlanta, GA, USA
| | - Elizabeth Barber
- Phoebe Putney Memorial Hospital, Mercer College of Pharmacy, Mercer University, Atlanta, GA, USA
| |
Collapse
|
35
|
Rehm KP, Brittan MS, Stephens JR, Mummidi P, Steiner MJ, Gay JC, Ayubi SA, Gujral N, Mittal V, Dunn K, Chiang V, Hall M, Blaine K, O'Neill M, McBride S, Rogers J, Berry JG. Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study. J Hosp Med 2018; 13:236-242. [PMID: 29394301 DOI: 10.12788/jhm.2934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many hospitals are considering contacting hospitalized patients soon after discharge to help with issues that arise. OBJECTIVE To (1) describe the prevalence of contactidentified postdischarge issues (PDI) and (2) assess characteristics of children with the highest likelihood of having a PDI. DESIGN, SETTING, PATIENTS A retrospective analysis of hospital-initiated follow-up contact for 12,986 children discharged from January 2012 to July 2015 from 4 US children's hospitals. Contact was made within 14 days of discharge by hospital staff via telephone call, text message, or e-mail. Standardized questions were asked about issues with medications, appointments, and other PDIs. For each hospital, patient characteristics were compared with the likelihood of PDI by using logistic regression. RESULTS Median (interquartile range) age of children at admission was 4.0 years (0-11); 59.9% were nonHispanic white, and 51.0% used Medicaid. The most common reasons for admission were bronchiolitis (6.3%), pneumonia (6.2%), asthma (5.1%), and seizure (4.9%). Twenty-five percent of hospitalized children (n=3263) reported a PDI at contact (hospital range: 16.0%-62.8%). Most (76.3%) PDIs were related to follow-up appointments (eg, difficulty getting one); 20.8% of PDIs were related to medications (eg, problems filling a prescription). Patient characteristics associated with the likelihood of PDI varied across hospitals. Older age (age 10-18 years vs <1 year) was significantly (P<.001) associated with an increased likelihood of PDI in 3 of 4 hospitals. CONCLUSIONS PDIs were identified often through hospital-initiated follow-up contact. Most PDIs were related to appointments. Hospitals caring for children may find this information useful as they strive to optimize their processes for follow-up contact after discharge.
Collapse
Affiliation(s)
- Kris P Rehm
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mark S Brittan
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John R Stephens
- North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Pradeep Mummidi
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Michael J Steiner
- North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - James C Gay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Nitin Gujral
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vandna Mittal
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kelly Dunn
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vincent Chiang
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas, USA
| | - Kevin Blaine
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Sarah McBride
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jayne Rogers
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay G Berry
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Baskin RM, Zhang J, Dirain C, Lipori P, Fonseca G, Sawhney R, Boyce BJ, Silver NL, Dziegielewski PT. Predictors of returns to the emergency department after head and neck surgery. Head Neck 2017; 40:498-511. [DOI: 10.1002/hed.25019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/30/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- R. Michael Baskin
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Jingnan Zhang
- Department of Biostatistics; University of Florida; Gainesville Florida
| | - Carolyn Dirain
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Paul Lipori
- College of Medicine; University of Florida; Gainesville Florida
| | - Gileno Fonseca
- College of Medicine; University of Florida; Gainesville Florida
| | - Raja Sawhney
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Brian J. Boyce
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Natalie L. Silver
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology; University of Florida; Gainesville Florida
- University of Florida Health Cancer Center; Gainesville Florida
| |
Collapse
|
37
|
Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review. Res Social Adm Pharm 2017; 14:707-717. [PMID: 29100941 DOI: 10.1016/j.sapharm.2017.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms "telemedicine", "telehealth", and "telephone" were used in combination with "pharmacist" or "pharmacy" and "telepharmacy". The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence. RESULTS Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4). CONCLUSIONS Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study.
Collapse
Affiliation(s)
- Joshua D Niznik
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States.
| | - Harvey He
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; Critical Care Medicine, Biomedical Informatics and Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States; UPMC, Pittsburgh, PA, United States
| |
Collapse
|
38
|
Morath B, Mayer T, Send AFJ, Hoppe-Tichy T, Haefeli WE, Seidling HM. Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach. Br J Clin Pharmacol 2017; 83:2163-2178. [PMID: 28452063 DOI: 10.1111/bcp.13318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.
Collapse
Affiliation(s)
- Benedict Morath
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Hospital Pharmacy, Heidelberg University, Im Neuenheimer Feld 670, 69120, Heidelberg, Germany
| | - Tanja Mayer
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Alexander Francesco Josef Send
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Torsten Hoppe-Tichy
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Hospital Pharmacy, Heidelberg University, Im Neuenheimer Feld 670, 69120, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna Marita Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| |
Collapse
|
39
|
Carmichael J, Jassar G, Nguyen PAA. Healthcare metrics: Where do pharmacists add value? Am J Health Syst Pharm 2016; 73:1537-47. [PMID: 27521240 DOI: 10.2146/ajhp151065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
40
|
Splawski J, Minger H. Value of the Pharmacist in the Medication Reconciliation Process. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2016; 41:176-8. [PMID: 26957885 PMCID: PMC4771087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Involving pharmacists in the process of comparing the medications that should be ordered for a patient with the new medications that are currently ordered and resolving differences improves accuracy, decreases mortality, and improves transitions of care.
Collapse
|