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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.
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Varghese S, Hahn-Goldberg S, Deng Z, Bradley-Ridout G, Guilcher SJT, Jeffs L, Madho C, Okrainec K, Rosenberg-Yunger ZRS, McCarthy LM. Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review. Patient Prefer Adherence 2022; 16:515-560. [PMID: 35241910 PMCID: PMC8887864 DOI: 10.2147/ppa.s348152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings. METHODS Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer. RESULTS A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers). CONCLUSION The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.
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Affiliation(s)
- Shawn Varghese
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Michael G.Degroote School Of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - ZhiDi Deng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glyneva Bradley-Ridout
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sinai Health, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Craig Madho
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Karen Okrainec
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, School of Health Services Management, Ryerson University, Toronto, Ontario, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Correspondence: Lisa M McCarthy, Clinician Scientist, Institute for Better Health, Trillium Health Partners, Tel +1 416-566-2793, Email
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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
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Li H, Powell V, Tsapepas D. Expanding Pharmacy Services With an Intern Program at an Academic Medical Center. J Pharm Pract 2020; 35:57-61. [PMID: 32815470 DOI: 10.1177/0897190020949425] [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 Organizations that implement pharmacy services to provide patient education have reduced hospital readmissions and improved the patient experience. The term "pharmacy extender" has been used to describe pharmacy technicians and pharmacy students who alleviate the workload of a pharmacist, enhance pharmacy visibility throughout an organization, and foster professional development for the individual. OBJECTIVE The objective of this pharmacy intern-driven program is to increase pharmacy reach for medication teaching. METHODS This is a single-center, IRB-approved retrospective cohort analysis. Pharmacist-led medication teaching is currently available to select high-risk populations including solid organ transplant and bone marrow transplant recipients at our organization. Clinicians working in the pharmacy satellites have structured operational and distributional workflow responsibilities, which precludes them from directly engaging with patients. Pharmacy interns can serve as extenders that can participate in medication teaching. An internally created digital medication teaching tool will be employed to expand the pharmacy reach for medication education. RESULTS During the period of study, the pharmacy interns screened 3,993 patients and educated 2,868 patients. Two-thirds of the pharmacy interns that participated in the program pursued post-graduate residency or fellowship training, while the rest assumed hospital pharmacist positions. CONCLUSION Deploying pharmacy interns as extenders for distribution of an internally created digital tool that provides general medication teaching has shown positive outcomes including greater pharmacy presence and visibility, better patient experience, and higher patient satisfaction. Continuous data collection and monitoring are warranted to demonstrate the benefits of the program once sustained and potentially justify more resources for further expansion.
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Affiliation(s)
- Hanlin Li
- Department of Pharmacy, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Vickie Powell
- Department of Pharmacy, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Demetra Tsapepas
- Department of Pharmacy, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA.,Department of Transplantation, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA.,Department of Surgery, Columbia University, New York, NY, USA
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5
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Snyder ME, Krekeler CE, Jaynes HA, Davis HB, Lantaff WM, Shan M, Perkins SM, Zillich AJ. Evaluating the effects of a multidisciplinary transition care management program on hospital readmissions. Am J Health Syst Pharm 2020; 77:931-937. [DOI: 10.1093/ajhp/zxaa091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
To measure the effect of a pharmacist-initiated transitions of care (TOC) program on rates of 30-day all-cause readmissions and primary care follow-up.
Methods
A retrospective cohort study was conducted to evaluate a pharmacist-initiated TOC program for patients discharged from hospitals of a large health system from September 2015 through July 2016. Discharged patients of 13 primary care physicians (the intervention cohort) received TOC program services, and discharged patients seen by 12 other primary care physicians (the control cohort) received usual care. Patients in both cohorts were followed for 90 days. The primary outcome was 30-day all-cause readmissions, and secondary outcomes were 14-day primary care visits, TOC pharmacist identification and resolution of medication therapy problems (MTPs), and transition care management (TCM) billing. Multivariable modeling was performed to test the associations of patient receipt of TOC services with 30-day readmissions and 14-day primary care visits, with controlling for patient demographics and baseline healthcare utilization.
Results
A total of 492 patients received the TOC intervention, and 379 were followed in the usual care cohort. Among intervention patients, 960 MTPs were identified, and 85.7% of identified MTPs were resolved. Moreover, 9% of intervention cohort patients were readmitted within 30 days, compared to 15% of control cohort patients, and this effect was significant in the multivariable model (odds ratio, 1.82; 95% confidence interval, 1.15-2.89; P = 0.0108). Rates of primary care visits did not differ significantly between the groups; 65% of intervention group visits were billed using TCM codes.
Conclusion
A pharmacist-initiated TOC program was effective in reducing 30-day all-cause readmissions.
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Affiliation(s)
| | | | | | | | - Wendy M Lantaff
- Eudaemonia Health, LLC, Indianapolis, IN
- Walmart Pharmacy, Indianapolis, IN
| | - Mu Shan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Susan M Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Alan J Zillich
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN
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Borhanjoo P, Kouamo P, Rahman M, Norton M, Gavini M. Effect of clinical pharmacist encounters in the transitional care clinic on 30-day re-admissions: A retrospective study. AIMS Public Health 2019; 6:345-354. [PMID: 31637283 PMCID: PMC6779605 DOI: 10.3934/publichealth.2019.3.345] [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] [Received: 06/20/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
Hospitalized patients who meet specific criteria at discharge are referred to the transitional care clinic team consisting of a nurse practitioner and/or physician and a clinical pharmacist. In collaboration with the providers, the pharmacist reviews medications for appropriateness, assesses adherence, recommends medication changes and provides education. The purpose of this study was to measure the effect of an outpatient transitional care clinical pharmacist on 30-day re-admissions in an urban setting serving a population of low socioeconomic status. After receiving IRB approval, this single-center retrospective study analyzed records of 573 patient visits of which nearly 75% included a clinical pharmacist interaction. Rates of 30-day re-admissions were not statistically different among the two groups, however, it was found that each added co-morbidity significantly increased the patients' 30-day re-admission rate by 26%.
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Affiliation(s)
- Panid Borhanjoo
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y. 11213, U.S.A.
| | - Priscile Kouamo
- School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A.
| | - Mafuzur Rahman
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y. 11213, U.S.A.
| | - Margaret Norton
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y. 11213, U.S.A.
| | - Madhavi Gavini
- Department of Family Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A.
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Lash DB, Mack A, Jolliff J, Plunkett J, Joson JL. Meds-to-Beds: The impact of a bedside medication delivery program on 30-day readmissions. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- David B. Lash
- Department of Pharmacy; Kern Medical; Bakersfield California
| | - Angela Mack
- Department of Pharmacy; Kern Medical; Bakersfield California
| | - Jeffrey Jolliff
- Department of Pharmacy; Kern Medical; Bakersfield California
| | - Joshua Plunkett
- Department of Pharmacy; Kern Medical; Bakersfield California
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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
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9
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Johnson TJ, Brownlee MJ. Development and innovation of system resources to optimize patient care. Am J Health Syst Pharm 2018; 75:465-472. [DOI: 10.2146/ajhp170402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Michael J. Brownlee
- University of Iowa Health Care, Iowa City, IA
- University of Iowa College of Pharmacy, Iowa City, IA
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