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McCormick C, Bhatnagar M, Arnold RM, Lowry MF. Description and Outcomes of a Palliative Care Pharmacist-Led Transitions of Care Program. J Palliat Med 2024; 27:675-680. [PMID: 38451551 DOI: 10.1089/jpm.2023.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Background: Patients with palliative care needs are at high risk of medication errors during transitions of care (TOC). Palliative Care Pharmacist Interventions surrounding Medication Prescribing Across Care Transitions (IMPACT) program was developed to improve the TOC process from hospital to community setting for cancer patients followed by palliative care. We describe (1) the program and (2) pilot study feasibility and effectiveness data. Methods: We recorded pharmacist time, medication errors, drug therapy problems (DTPs), and palliative care provider satisfaction and compared 7- and 30-day readmissions and emergency department (ED) visits between IMPACT and usual care patients. Results: Forty-four patients were reached by the pharmacist. The pharmacist spent an average of 65 minutes per patient. An average of 14.9 medication reconciliation discrepancies per patient and a total 76 DTPs were identified. Seven-day readmissions were lower in the IMPACT group versus usual care; there were no differences in 30-day readmission or 7- or 30-day ED visits. Conclusion: Our pilot study demonstrates that integrating a pharmacist in TOC for seriously ill patients is feasible and valuable.
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Affiliation(s)
- Connor McCormick
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Mamta Bhatnagar
- University of Pittsburgh Medical Center (UPMC), Palliative and Supportive Institute, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- University of Pittsburgh Medical Center (UPMC), Palliative and Supportive Institute, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh, Palliative Research Center, Pittsburgh, Pennsylvania, USA
| | - Maria Felton Lowry
- University of Pittsburgh Medical Center (UPMC), Palliative and Supportive Institute, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, Pennsylvania, USA
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2
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Costello J, Barras M, Foot H, Cottrell N. The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100305. [PMID: 37655116 PMCID: PMC10466898 DOI: 10.1016/j.rcsop.2023.100305] [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: 09/28/2022] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. Aims To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. Methods Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. Results Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. Conclusions A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.
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Affiliation(s)
- Jaclyn Costello
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Redcliffe Hospital, Metro North Health, Brisbane, QLD, Australia
| | - Michael Barras
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Holly Foot
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Neil Cottrell
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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3
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Mao W, Shalaby R, Agyapong VIO. Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature. Healthcare (Basel) 2023; 11:healthcare11081161. [PMID: 37107995 PMCID: PMC10138571 DOI: 10.3390/healthcare11081161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. OBJECT This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. METHOD The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. RESULT This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. CONCLUSION Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans, Memorial Lane, 8th Floor Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada
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4
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Cook EA, Duenas M, Harris P. Polypharmacy in the Homebound Population. Clin Geriatr Med 2022; 38:685-692. [PMID: 36210084 PMCID: PMC9468911 DOI: 10.1016/j.cger.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The number of homebound elders has risen dramatically in the past decade and was accelerated by the Sars-Cov-2 COVID-19 pandemic. These individuals generally have 5 or more chronic conditions, take 6 or more medications, and are at elevated risk for functional decline. Polypharmacy constitutes a major burden for these individuals, putting them at risk for medication nonadherence, medication errors, medication interactions, and reduced quality of life. A team-based approach may help these elders manage medications more effectively.
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Affiliation(s)
- Erin Atkinson Cook
- UCLA Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA
| | - Maria Duenas
- UCLA Department of Medicine, Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA
| | - Patricia Harris
- UCLA Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
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5
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The Future of Critical Care: Optimizing Technologies and a Learning Healthcare System to Potentiate a More Humanistic Approach to Critical Care. Crit Care Explor 2022; 4:e0659. [PMID: 35308462 PMCID: PMC8926065 DOI: 10.1097/cce.0000000000000659] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
While technological innovations are the invariable crux of speculation about the future of critical care, they cannot replace the clinician at the bedside. This article summarizes the work of the Society of Critical Care Medicine–appointed multiprofessional task for the Future of Critical Care. The Task Force notes that critical care practice will be transformed by novel technologies, integration of artificial intelligence decision support algorithms, and advances in seamless data operationalization across diverse healthcare systems and geographic regions and within federated datasets. Yet, new technologies will be relevant and meaningful only if they improve the very human endeavor of caring for someone who is critically ill.
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6
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Foster L, Choxi S, Rosenberg RE, Tracy J, Toscano D, Betancur Paez J, Glick AF. Meds to Beds: A Quality Improvement Approach to Optimizing the Discharge Medication Process for Pediatric Patients. Jt Comm J Qual Patient Saf 2021; 48:92-100. [PMID: 34740550 DOI: 10.1016/j.jcjq.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Using an on-site pharmacy or medication to bedside (MTB) program allows patients to obtain prescriptions and education before discharge, potentially improving adherence and preventing harm. The aim of this project was to improve discharge processes for pediatric acute care patients by increasing the proportion of oral antibiotics (1) prescribed to the on-site pharmacy from 15% to 70% and (2) delivered to bedside from 0% to 50%. METHODS The Model for Improvement was used to iteratively implement interventions: increased on-site pharmacy capabilities, MTB program creation and streamlined enrollment, and secure electronic health record (EHR) messaging between clinicians and pharmacy staff regarding prescriptions. Process measures were proportion of antibiotics prescribed to the on-site pharmacy and delivered to bedside. Outcomes included surveys of family satisfaction with discharge medication education and discharge medication-related safety reports. Discharge before noon (DBN) was the balancing measure. Aims were analyzed using statistical process control charts and chi-square tests. RESULTS A total of 1,908 antibiotics were prescribed over 28-months. On-site pharmacy prescriptions increased from 15% to 46% after pharmacy capabilities increased, then to 86% after MTB program launch, optimized workflow, and initiation of EHR messaging. Bedside medication delivery increased from 0% to 58% with these interventions. Family satisfaction with discharge medication education and frequency of discharge medication-related safety reports was not significantly different pre- and postintervention. DBN varied throughout the study. CONCLUSION Through clinician and pharmacy staff partnership, this initiative increased on-site pharmacy use and discharge antibiotics delivered to bedside. Key interventions included increased pharmacy capabilities, MTB program with streamlined workflow, and EHR-based communication.
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7
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Nair R, Johnson M, Kravitz K, Huded C, Rajeswaran J, Anabila M, Blackstone E, Menon V, Lincoff AM, Kapadia S, Khot UN. Characteristics and Outcomes of Early Recurrent Myocardial Infarction After Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e019270. [PMID: 34333986 PMCID: PMC8475017 DOI: 10.1161/jaha.120.019270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We aimed to understand the characteristics and outcomes of patients readmitted with a recurrent myocardial infarction (RMI) within 90 days of discharge after an acute myocardial infarction (early RMI). Methods and Results We analyzed the timing of reinfarction, etiology, and outcome for all patients admitted with an early RMI within 90 days of discharge after an acute myocardial infarction between January 1, 2010 and January 1, 2017. We identified 6626 admissions for acute myocardial infarction (index myocardial infarction) which led to 168 cases of RMI within 90 days of discharge. The mean patient age was 65.1±13.1 years, and 37% were women. The 90-day probability of readmission with an early RMI was 2.5%. Black race, medical management, higher troponin T, and shorter length of stay were independent predictors of early RMI. Medically managed group had a higher risk for early RMI compared with percutaneous coronary intervention (P=0.04) or coronary artery bypass grafting (P=0.2). Predominant mechanisms for reinfarction were stent thrombosis (17%), disease progression (12%), and unchanged coronary artery disease (11%). At 5 years, the all-cause mortality rate for patients with an early RMI was 49% (95% CI, 40%-57%) compared with 22% (95% CI, 21%-23%) for patients without an early RMI (P<0.0001). Conclusions Early RMI is a life-threatening condition with nearly 50% mortality within 5 years. Stent-related events and progression in coronary artery disease account for most early RMI. Medication compliance, aggressive risk factor management, and care transitions should be the cornerstone in preventing early RMI.
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Affiliation(s)
- Raunak Nair
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
| | - Michael Johnson
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.,University Cardiology Associates Augusta GA
| | - Kathleen Kravitz
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
| | - Chetan Huded
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.,Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Moses Anabila
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Eugene Blackstone
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Venu Menon
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - A Michael Lincoff
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Samir Kapadia
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Umesh N Khot
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
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8
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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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9
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Ashraf H, Warren E, Latner JP, Shah KB, Bell J, Lowe S, Phillips RG, Martinez K, Pommett C, Lindsay T, Adkins J, Sheffield L, Richter J, Keeley EC. Effect of Medication Adherence and Early Follow-Up on Unplanned Readmission Post-Myocardial Infarction: Quality Improvement in a Safety Net Hospital. Crit Pathw Cardiol 2021; 20:71-74. [PMID: 32657972 DOI: 10.1097/hpc.0000000000000231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medication nonadherence is a strong predictor of adverse events and unplanned 30-day readmissions in post-myocardial infarction (MI) patients. Nonadherence with dual antiplatelet therapy (DAPT) is of particular concern in post-MI patients, given the high rate of percutaneous coronary intervention in this population. Review of post-MI quality measures revealed that compared to national benchmarks, our safety net hospital had lower DAPT adherence rates and higher unplanned 30-day readmission rates. The aim was to improve these important quality measures by creating a transition of care pathway primarily focused on medication accessibility and affordability of DAPT and early follow-up. A multidisciplinary task force created a transition of care pathway that included bedside medication delivery, patient assistance program enrollment for medications, and follow-up within 10 days of discharge in a dedicated post-MI clinic. Resources for the pathway (personnel and hospital) were already available and repurposed. We compared quality measures of DAPT adherence, proportion of patients evaluated early after hospital discharge, and unplanned 30-day readmissions before and after the initiative. Following initiation of the transition of care pathway, DAPT adherence increased from 56% pre-intervention to 92% post-intervention (P < 0.0001). The proportion of patients scheduled for early clinic follow-up after discharge increased and unplanned 30-day readmissions decreased following initiation of the pathway. A transition of care pathway for post-MI patients using readily available resources was associated with increased DAPT adherence and decreased 30-day unplanned readmissions.
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Affiliation(s)
- Hassan Ashraf
- From the Department of Medicine, University of Florida, Gainesville, FL
| | | | - Joshua P Latner
- From the Department of Medicine, University of Florida, Gainesville, FL
| | - Khanjan B Shah
- From the Department of Medicine, University of Florida, Gainesville, FL.,Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Jessica Bell
- University of Florida Health Shands Hospital, Gainesville, FL
| | - Sarah Lowe
- University of Florida Health Shands Hospital, Gainesville, FL
| | - Rose G Phillips
- University of Florida Health Shands Hospital, Gainesville, FL
| | | | | | - Tammy Lindsay
- University of Florida Health Shands Hospital, Gainesville, FL
| | | | | | - Julie Richter
- University of Florida Health Shands Hospital, Gainesville, FL
| | - Ellen C Keeley
- From the Department of Medicine, University of Florida, Gainesville, FL.,Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
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10
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Duncan I, Fitzner K, Zhao E, Shtein Y. Patient Post-discharge Transitions and Inpatient Readmissions Impose Costly Burdens for Employers and Carriers. Popul Health Manag 2021; 24:722-726. [PMID: 33848438 DOI: 10.1089/pop.2021.0037] [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: 11/12/2022] Open
Abstract
Although the Centers for Medicare & Medicaid Services has focused on Medicare hospital readmissions for select diagnoses through the Hospital Readmissions Reduction program, there is no similar initiative for employers, who account for the majority of the 48% of private health care spending in the United States. Readmissions are costly and it is estimated that as many as half of these may be preventable. This study analyzes a national claims database to understand post-discharge transitions and their cost in the working population. Within an employer-sponsored, commercially-insured population, this study found that 4% of members are hospitalized annually and drive 37% of population health care cost. Of these members, 17% undergo additional admissions in the year following discharge and drive approximately 67% of the cost of the admitted population. This study found that the post-discharge site of care transitions has significant implications for the cumulative cost of care. More than a third of patients discharged home will transition to higher cost settings over the course of a year. Mental health and substance abuse diagnoses add significantly to admission/readmission rates and costs. Prior research indicates that post-discharge interventions that activate and engage patients in self-management are beneficial in mitigating overall cost and readmissions.
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Affiliation(s)
- Ian Duncan
- Statistics Department, University of California Santa Barbara, Santa Barbara, California, USA
| | - Karen Fitzner
- Santa Barbara Actuaries, Santa Barbara, California, USA
| | - Elaine Zhao
- Santa Barbara Actuaries, Santa Barbara, California, USA
| | - Yoni Shtein
- Laguna Health, San Francisco, California, USA
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11
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Lopez T, Nuffer W. Impact and Sustainability of a 10-year Community Pharmacy Disease Management Service. Innov Pharm 2021; 12:10.24926/iip.v12i1.3630. [PMID: 34007665 PMCID: PMC8102957 DOI: 10.24926/iip.v12i1.3630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Community pharmacy practice needs to demonstrate services beyond traditional dispensing roles to continue to function in a changing marketplace. Pharmacists have established themselves as being capable of improving patient outcomes and saving healthcare dollars by providing disease management services to patients. This paper describes a sustained community pharmacy-run disease management program that continued after a grassroots grant-funding effort in 2007. METHODS The city of Colorado Springs recognized the successes shown by the pharmacy during the Ten City Challenge funded project, and decided to financially support pharmacy diabetes care services. Partnering with the local School of Pharmacy, the pharmacist obtained advanced training and continued to deliver individualized counseling and management to approximately 100 patients per year for the past 14 years. Objective lab measurements (systolic and diastolic blood pressures, A1C values, total lipid profiles) were obtained or performed, and clinical goals were set based on national guidelines. Patients received a series of appointments to learn how to control their diabetes, and later their cardiovascular disease. Financial estimates were calculated using 2008 baseline numbers and adding estimated inflation based on published Segal rates. RESULTS The pharmacy services successfully maintained participation of approximately 100 patients annually each year since its inception. Average lab value markers for disease control were at or close to clinical guideline recommendations for the population. Services were associated with estimated cost savings for the health system. Positive results led to expansion in services to include cardiovascular disease in 2017. CONCLUSIONS A community pharmacy has successfully sustained a disease management program for patients for over 14 years, demonstrating high patient enrollment, health outcomes at or near clinical guidelines for control, and positive financial outcomes associated with the program.
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Affiliation(s)
- Tammy Lopez
- City Employee Pharmacy, Colorado Springs; Maxor National Pharmacy Services, LLC
| | - Wesley Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
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12
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Joseph T, Hale GM, Moreau C. Training pharmacy residents as transitions of care specialists: a United States perspective. Int J Clin Pharm 2021; 43:756-758. [PMID: 33439425 DOI: 10.1007/s11096-021-01231-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
Transitions of care has emerged as a point of vulnerability in global health care systems, which can lead to potential avoidable medical errors. In the United States, pharmacist-led transitions of care programs are increasing in number, with many hospitals offering discharge prescription services. However, the required training for these positions remains unclear. With the lack of accreditation standards by the American Society of Health-System Pharmacists for transitions of care as a post-graduate year 2 specialty, this leads to the unanswered question: Which pharmacists are qualified for the growing number of transitions of care positions? Whether trained in a formal transitions of care specialty residency or not, pharmacists as a profession should reassess the proper qualifications needed to provide transitions of care services. One central message remains clear in that having a pharmacist on any interdisciplinary team who is knowledgeable about inpatient and community settings and administrative tasks involved in transitions of care while understanding optimal evidence-based recommendations would appear to be an important piece to the puzzle.
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Affiliation(s)
- Tina Joseph
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - Genevieve M Hale
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA.
| | - Cynthia Moreau
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
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13
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Acute Medical Conditions: Cardiopulmonary Disease, Medical Frailty, and Renal Failure. BRADDOM'S PHYSICAL MEDICINE AND REHABILITATION 2021. [PMCID: PMC7530618 DOI: 10.1016/b978-0-323-62539-5.00027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Witcraft EJ, Norris AM, Fudzie SS, Vest MH, Johnson N, Rush J, Colmenares EW. Impact of medication bedside delivery program on hospital readmission rates. J Am Pharm Assoc (2003) 2020; 61:95-100.e1. [PMID: 33199165 DOI: 10.1016/j.japh.2020.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since the establishment of the Hospital Readmission Reduction Program by the Centers for Medicare and Medicaid Services, reducing readmission rates has been a priority for health care institutions. Many institutions have developed services to combat high readmission rates, including bedside medication delivery programs, which have demonstrated reductions in 30-day readmission rates in patients who used these services. OBJECTIVE To evaluate the impact of health system-based bedside medication delivery programs on readmission rates in patients at a low to moderate risk of hospital readmission. METHODS A single-center retrospective cohort study conducted on adult patients of low-to moderate-transitions of care (TOC) risk status with unplanned admissions to a large academic medical center between January 1, 2017, and January 1, 2019 who used the medication bedside delivery service or an outside pharmacy. The TOC risk status was defined using historic institutional definitions. Patients with at least a 2-day hospital stay and who were discharged to home from select primary medical services were included. The primary outcome was 30-day readmission rates between the 2 groups. Secondary outcomes included 60- and 90-day readmission rates and readmission rates stratified by primary medical service and TOC status. Coarsened exact matching was used to account for variation between groups. RESULTS The study evaluated 6583 patients discharged with a total of 3905 patients and corresponding index admissions meeting inclusion criteria for analysis. No statistically significant difference between readmission rates at 30 days after the index admission was found between the medication bedside delivery group and the outside pharmacy group, 7.97% and 10.09%, respectively (P = 0.136). However, the readmission rate of the medication bedside delivery group was statistically significantly lower than that of the outside pharmacy group at 60 and 90 days. CONCLUSIONS This study suggests that bedside medication delivery programs do not significantly reduce readmission rates at 30 days but may do so at 60 and 90 days.
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15
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Agarwal P, Poeran J, Meyer J, Rogers L, Reich DL, Mazumdar M. Bedside medication delivery programs: suggestions for systematic evaluation and reporting. Int J Qual Health Care 2020; 31:G53-G59. [PMID: 31053860 DOI: 10.1093/intqhc/mzz014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 12/04/2018] [Accepted: 02/12/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Several factors lead to medication non-adherence after hospital discharge. Hospitals and pharmacies have implemented bedside medication delivery (BMD) programs for patients, in an attempt to reduce barriers and improve medication adherence. Here, we provide a critical review of the literature on these programs. DATA SOURCES We conducted a literature search on BMD programs in PubMed, Google Scholar, Scopus and a general Google search using these keywords: 'medication delivery bedside', 'discharge medication delivery', 'meds to bedside' and 'meds to beds'. STUDY SELECTION We identified 10 reports and include data from all reports. DATA EXTRACTION Data on study characteristics and settings were extracted along with four outcomes: medication error, patient satisfaction, 30-day hospital readmission and visits to the emergency department. RESULTS OF DATA SYNTHESIS Of the 10 reports, only 4 were peer-reviewed publications; others were reported in the lay press. Outcomes were reported in both qualitative and quantitative terms. Less than half of reports provided quantitative data on 30-day readmission and patient satisfaction. Others suggested qualitative improvement in these outcomes but did not provide data or specific details. None reported outcomes of their programs beyond 30 days. CONCLUSION We highlight the need for increased use of optimal program design and more rigorous evaluations of the impact of BMD programs. We also provide guidelines on the types of evaluations that are likely needed and encourage improved reporting.
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Affiliation(s)
- Parul Agarwal
- Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York NY 10029, USA
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York NY 10029, USA
| | - Joanne Meyer
- Department of Pharmacy, The Mount Sinai Hospital, Annenberg B2-12, One Gustave L. Levy Place, Box 1211, New York NY 10029, USA
| | - Linda Rogers
- Mount Sinai-National Jewish Respiratory Institute, The Mount Sinai Hospital, 10 East 102nd Street, 5th Floor, New York NY 10029, USA
| | - David L Reich
- Anesthesiology and Perioperative Pain Medicine, The Mount Sinai Hospital, 10 East 102nd Street, 5th Floor, New York NY 10029, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York NY 10029, USA
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Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative. Am J Med 2020; 133 Suppl 1:1-27. [PMID: 32362349 DOI: 10.1016/j.amjmed.2019.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022]
Abstract
Hospitalized patients with acute medical illnesses are at risk for venous thromboembolism (VTE) during and after a hospital stay. Risk factors include physical immobilization and underlying pathophysiologic processes that activate the coagulation pathway and are still present after discharge. Strategies for optimal pharmacologic VTE thromboprophylaxis are evolving, and recommendations for VTE prophylaxis can be further refined to protect high-risk patients after hospital discharge. An early study of extended VTE prophylaxis with a parenteral agent in medically ill patients yielded inconclusive results with regard to efficacy and bleeding. In the Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial, extended use of betrixaban halved symptomatic VTE, decreased hospital readmission, and reduced stroke and major adverse cardiovascular events compared with standard enoxaparin prophylaxis. Based on findings from APEX, the Food and Drug Administration approved betrixaban in 2017 for extended VTE prophylaxis in acute medically ill patients. In the Reducing Post-Discharge Venous Thrombo-Embolism Risk (MARINER) study, extended use of rivaroxaban halved symptomatic VTE in high-risk medical patients compared with placebo. In 2019, rivaroxaban was approved for extended thromboprophylaxis in high-risk medical patients, thus making available a new strategy for in-hospital and post-discharge VTE prevention. To address the critical unmet need for VTE prophylaxis in medically ill patients at the time of hospital discharge, the North American Thrombosis Forum (NATF) is launching the Anticoagulation Action Initiative, a comprehensive consensus document that provides practical guidance and straightforward, patient-centered recommendations for VTE prevention during hospitalization and after discharge.
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Segal JB, Apfel A, Brotman DJ, Shermock KM, Clark JM. Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission. J Manag Care Spec Pharm 2020; 26:296-304. [PMID: 32105180 PMCID: PMC10390977 DOI: 10.18553/jmcp.2020.26.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study is an evaluation of a discharge intervention that occurred in multiple hospitals across Maryland. In this program, patients received medications at their bedside before discharge with the goal of reducing the risk of primary nonadherence to prescribed medications. OBJECTIVE To test if the intervention reduced the risk of 30-day readmission for the patients who received bedside medication delivery relative to comparable patients who did not receive bedside medication delivery. METHODS This was a retrospective cohort study. Patients who received the intervention were linked to their claims data in the Maryland Health Information Exchange. These patients were matched on age, sex, diagnosis-related group, and hospital to a set of patients who did not receive the intervention. We used propensity score matching, as well as inverse-probability weighting, to account for residual differences between the treated and comparison patients. With robust Poisson regression, adjusting for hospital, we generated risk ratios for 30-day readmission and explored risk ratios in key subgroups. RESULTS The cohort included 6,167 inpatients who received medications at bedside and 28,546 who did not from 10 Maryland hospitals. They were 60% female, 61% white, and 31% African American; the average age was 56 years. The risk ratio for readmission, comparing the intervention group to the propensity score-matched comparison group, was 1.21 (95% CI = 0.96-1.5). Inverse-probability weighting yielded a similar result (1.19 [95% CI = 0.98-1.45]). CONCLUSIONS In this study, the isolated intervention of bedside medication delivery did not reduce 30-day readmission risk. We expect it may have favorable outcomes on other metrics such as primary nonadherence and patient satisfaction. It may also have a favorable effect when bundled with other care transition activities. As an isolated intervention, however, bedside medication delivery is unlikely to affect 30-day readmission rates. DISCLOSURES This study was funded by Walgreen Co. through unrestricted funds to Johns Hopkins University, which has received fees from Walgreens for providing consultation as an institution to Walgreens. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Segal received a grant from the National Institute on Aging during the conduct of this study. The other authors have nothing to disclose.
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Affiliation(s)
- Jodi B. Segal
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ariella Apfel
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel J. Brotman
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth M. Shermock
- Division of General Internal Medicine and Health System Department of Pharmacy, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeanne M. Clark
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Prusaczyk B, Mixon AS, Kripalani S. Implementation and Sustainability of a Pharmacy-Led, Hospital-Wide Bedside Medication Delivery Program: A Qualitative Process Evaluation Using RE-AIM. Front Public Health 2020; 7:419. [PMID: 32039130 PMCID: PMC6988304 DOI: 10.3389/fpubh.2019.00419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/30/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Few studies of hospital-based implementation assess sustainability or collect formal implementation outcomes, in part because the emphasis is often on initial adoption and rapid cycles of improvement. The purpose of this process evaluation was to assess the implementation of a pharmacy-led, hospital-wide program and contribute to the literature by collecting formal implementation outcomes, including sustainability. Methods: This was a qualitative process evaluation of a program that delivers discharge medications and related education to hospitalized patients' bedside prior to discharge. Semi-structured interviews were conducted with the program's key stakeholders to assess the program's implementation barriers and facilitators as well as its potential for sustainability. An interview guide was created based on the RE-AIM constructs of Reach, Adoption, Implementation, and Maintenance. Effectiveness was not assessed due to an ongoing effectiveness evaluation by another team. Each interview was coded by two independent coders and any discrepancy was adjudicated by a third, independent coder. Results: Twelve stakeholders were approached and all agreed to be interviewed. Related to providers' decisions to adopt the program, key themes emerged around the different priorities of nurses and physicians, which has implications for how program leadership promoted the program to these different stakeholder groups. Key implementation barriers included the nature of hospital provider rotations and turnover, which led to confusion on who could use the program and to whom providers should direct program-related questions. Key implementation facilitators included the enthusiasm of program staff and identified champions on the units. Themes related to maintenance or sustainability included the need to continually generate buy-in and educate providers about the program and allowing program staff and leadership to remain nimble and adapt their operations to meet evolving needs. Conclusions: The results suggest that in an environment in which rapidly achieving improvement is often the focus more than maintaining that improvement, strategies to achieve successful implementation may not be sufficient to achieve successful sustainment. New strategies are likely needed to address the unique barriers to sustaining a program once initial adoption and implementation is complete.
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Affiliation(s)
- Beth Prusaczyk
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda S Mixon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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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]
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Tillman F, Greenberg J, Liu I, Khalid S, McGuire N, Harris SC. Assessment of pharmacy-driven transitional interventions in hospitalized patients with psychiatric disorders. J Am Pharm Assoc (2003) 2019; 60:22-30. [PMID: 31859220 DOI: 10.1016/j.japh.2019.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/29/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Pharmacy-driven transitions of care (TOC) services for psychiatric patient populations have not been systematically evaluated. The primary objective was to assess pharmacy TOC services for patients hospitalized for psychiatric care at an academic medical center. The secondary objectives were to evaluate the incidence of psychiatric-associated readmission, emergency department (ED) presentations, or both and outpatient clinic follow-up 30 days after discharge, in addition to characterizing the types and frequencies of psychotropic medications prescribed at discharge. DESIGN Retrospective, double-cohort study. SETTING AND PARTICIPANTS This study compares adult patients who received at least 1 pharmacy-driven TOC intervention before discharge from a psychiatric unit between June 1, 2017, and June 30, 2018, with a historical control group that was discharged between June 1, 2016, and May 31, 2017. Interventions included discharge education on selected high-risk medications, medication barriers assessment, TOC notes to outpatient providers, postdischarge telecommunication, and bedside medication delivery. OUTCOME MEASURES The percentage of pharmacy TOC services provided for patients hospitalized for psychiatric care at an academic medical center and the incidence of psychiatric-associated readmission, ED presentations, or both and outpatient clinic follow-up 30 days after discharge. RESULTS Fifty-three and 104 electronic health records were reviewed within the control and intervention groups, respectively. The most common interventions were discharge education (22.7%), bedside delivery of medications (22.7%), and medication barrier assessments (22.2%). Adherence (26.8%) and cost (19.5%) were the most common medication barriers. Thirty-day psychiatric-associated readmissions, ED presentations, or both occurred in 32.4% and 15.4% of patients in the control and intervention groups, respectively (P < 0.001). Of the patients, 15.1% and 20.1% presented for outpatient follow-up in the control and intervention groups, respectively (P < 0.001). Statistically, more patients in the control group were prescribed antidepressants at discharge (41.8% vs. 13.1%), whereas more patients in the intervention group were prescribed lithium (10.9% vs. 4.3%) and antipsychotics other than clozapine (40.0% vs. 25.9%). CONCLUSION The findings show significant differences in clinical outcomes between patients receiving and not receiving pharmacy-driven transitional interventions. Future prospective studies are warranted to further elucidate these observations.
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Bonetti AF, Bagatim BQ, Bottacin WE, Mendes AM, Rotta I, Reis RC, Fávero MLD, Fernandez-Llimos F, Pontarolo R. Pharmacotherapy problems in cardiology patients 30 days post discharge from a tertiary hospital in Brazil: a randomized controlled trial. Clinics (Sao Paulo) 2019; 74:e1091. [PMID: 31778428 PMCID: PMC6862706 DOI: 10.6061/clinics/2019/e1091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/02/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil. METHODS At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge. RESULTS A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: "incorrect time of taking" (p=0.003), "use higher dose of medication" (p=0.007), "use lower dose of medication" (p=0.014), "restart discontinued medication" (p=0.011), and "underdosing prescription" (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems. CONCLUSIONS We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.
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Affiliation(s)
- Aline F. Bonetti
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Bruna Q. Bagatim
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
| | | | - Antonio M. Mendes
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Inajara Rotta
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Renata C. Reis
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Maria Luiza D. Fávero
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Institute for Medicines Research (iMed. ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Roberto Pontarolo
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR
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Patel A, Dodd MA, D'Angio R, Hellinga R, Ahmed A, Vanderwoude M, Sarangarm P. Impact of discharge medication bedside delivery service on hospital reutilization. Am J Health Syst Pharm 2019; 76:1951-1957. [PMID: 31724038 DOI: 10.1093/ajhp/zxz197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. METHODS A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. RESULTS A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45-1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. CONCLUSION There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.
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Affiliation(s)
- Avni Patel
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Melanie A Dodd
- Department of Pharmacy Practice and Administrative Sciences, The University of New Mexico College of Pharmacy Albuquerque, NM
| | - Richard D'Angio
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Robert Hellinga
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Ali Ahmed
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Michael Vanderwoude
- Ambulatory Care Services, Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
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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.
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The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery. PHARMACY 2019; 7:pharmacy7020068. [PMID: 31248090 PMCID: PMC6631279 DOI: 10.3390/pharmacy7020068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The hospital transitional care coordinator nurse referred qualified patients to the DCP nurse coordinator, who scheduled telephonic medication therapy management (MTM) reviews with the DCP pharmacist at one- and three-weeks postdischarge. Hospital records and DCP documentation were reviewed to describe respective interventions and assess the impact on 30-day readmissions. A total of 456 patients were referred to the DCP between 31 August, 2015 and 7 September, 2016. Of the 340 patients who participated (DCP group), 44 (13%) compared to 17% (n = 20) of the usual care, were readmitted within 30-days postdischarge. The DCP pharmacists conducted 1242 clinical interventions with participants, demonstrating the benefits of an interprofessional TOC model involving multiple, pharmacist-delivered MTM intervention touchpoints within 30 days post-hospital discharge.
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Lam SW, Sokn E. Effect of Pharmacy-Driven Bedside Discharge Medication Delivery Program on Day 30 Hospital Readmission. J Pharm Pract 2019; 33:628-632. [PMID: 30727808 DOI: 10.1177/0897190019825961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies demonstrated that transitions of care bundles, which include bedside discharge medication delivery (BDMD), may be helpful in decreasing hospital readmissions. OBJECTIVE To evaluate the effects of BDMD alone on day 30 readmission rates. METHODS Retrospective, cohort study comparing those who received pharmacy-driven BDMD to usual discharge. Primary outcome was day 30 readmission rates. Multivariable logistic regression was used to account for baseline differences between groups. RESULTS A total of 30916 patients met inclusion and exclusion criteria. Of those, 2253 (7%) received BDMD and 28663 (93%) received usual care. Significant differences in age, distance from hospital, race, marital status, insurance type, previous hospitalizations, admission source, baseline comorbidities, and medication counts were observed between groups. Patients who received BDMD were less likely to have day 30 readmissions (10.6% vs 12.8%, P = .002). However, after adjusting for baseline characteristics, BDMD was not an independent predictor of day 30 readmission (adjusted odds ratio = 0.91, 95% confidence interval = 0.79-1.04, P = .17). BDMD was associated with decreased day 14 readmissions in an unadjusted analysis. CONCLUSIONS BDMD was not independently associated with a reduction in day 30 readmissions. Future studies should focus on targeting patients who are most likely to benefit from this service.
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Affiliation(s)
- Simon W Lam
- Pharmacoeconomics and Outcomes Research, Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Erick Sokn
- Transitions of Care, Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA
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Eliciting nurses' perspectives to improve health information exchange between hospital and home health care. Geriatr Nurs 2018; 40:277-283. [PMID: 30503605 DOI: 10.1016/j.gerinurse.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 12/27/2022]
Abstract
Despite patient safety initiatives to improve care transitions, prior research largely neglects to elicit feedback from home health nurses regarding health information exchange. The goal of this quality improvement study was to identify opportunities to facilitate information transfer during hospital-to-home-health-care transitions for older adults with heart failure. We conducted focus groups with 19 nurses employed by a single healthcare system using two commercially available electronic health record (EHR) vendors. We analyzed interview transcripts following an immersion/crystallization approach to identify themes. Average participants were females in their mid-fifties with 15 years of home health experience. Nurses reported challenges with hospital-to-home-health-care information exchange, specifically: 1) poor medication management, 2) ineffective communication, 3) technology issues, and 4) patient factors. Nurses identified several opportunities for improvement, including discordant EHR-generated medication lists, which may be amenable to technological solutions. Local quality improvement efforts should incorporate nurses' suggestions and leverage existing best practices.
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Gale R. In Patient Safety Efforts, Pharmacists Gain New Prominence. Health Aff (Millwood) 2018; 37:1726-1729. [DOI: 10.1377/hlthaff.2018.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rebecca Gale
- Rebecca Gale is a journalist and writer based in Bethesda, Maryland
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McAuliffe LH, Zullo AR, Dapaah-Afriyie R, Berard-Collins C. Development and validation of a transitions-of-care pharmacist tool to predict potentially avoidable 30-day readmissions. Am J Health Syst Pharm 2018; 75:111-119. [PMID: 29371191 DOI: 10.2146/ajhp170184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A practical tool for predicting the risk of 30-day readmissions using data readily available to pharmacists before hospital discharge is described. METHODS A retrospective cohort study to identify predictors of potentially avoidable 30-day readmissions was conducted using transitions-of-care pharmacy notes and electronic medical record data from a large health system. Through univariate and multivariable logistic regression analyses of factors associated with unplanned readmissions in the study cohort (n = 690) over a 22-month period, a risk prediction tool was developed. The tool's discriminative ability was assessed using the C statistic; its calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. RESULTS Three factors predictive of readmission risk were identified; these variables-medication count, comobidity count, and health insurance status at discharge-form the 3-predictor MEDCOINS score. Among patients identified as being at high risk for readmission using the MEDCOINS tool, the estimated readmission risk was 22.5%, as compared with an observed readmission rate of 21.9%. The discriminatory performance of MEDCOINS scoring was fair (C statistic = 0.65 [95% confidence interval, 0.60-0.70]), with good calibration (Hosmer-Lemeshow p = 0.99). CONCLUSION Among a cohort of patients who were seen by a transitions-of-care pharmacist during an inpatient hospitalization, comorbidity burden, number of medications, and health insurance coverage were most predictive of 30-day readmission. The MEDCOINS tool was found to have fair discriminative ability and good calibration.
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Affiliation(s)
| | - Andrew R Zullo
- Lifespan Corporation-Rhode Island Hospital, Providence, RI.,Department of Health Services, Policy, and Practice, Brown University, Providence, RI
| | | | - Christine Berard-Collins
- Lifespan Corporation-Rhode Island Hospital, The Miriam Hospital, Bradley Hospital, Lifespan Pharmacy, LLC, Providence, RI
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Matzke GR, Moczygemba LR, Williams KJ, Czar MJ, Lee WT. Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization. Am J Health Syst Pharm 2018; 75:1039-1047. [PMID: 29789318 DOI: 10.2146/ajhp170789] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described. METHODS Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system. A total of 2,480 evaluable patients were included in both the collaborative care group and the usual care group. The primary clinical outcomes measured were the absolute change in values associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline within and between the collaborative care and usual care groups. RESULTS Significant improvements (p < 0.01) in glycosylated hemoglobin, blood pressure, low-density-lipoprotein cholesterol, and total cholesterol were observed in the collaborative care group compared with the usual care group. Hospitalizations declined significantly in the collaborative care group (23.4%), yielding an estimated cost savings of $2,619 per patient. The return on investment (net savings divided by program cost) was 504%. CONCLUSION Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based PCMH model was associated with significant improvements in patients' medication-related clinical health outcomes and a reduction in hospitalizations.
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Affiliation(s)
- Gary R Matzke
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University School of Pharmacy, Richmond, VA.
| | - Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, University of Texas at Austin College of Pharmacy, Austin, TX
| | | | - Michael J Czar
- Department of Pharmacy, Carilion New River Valley Medical Center, Christiansburg, VA
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Bonetti AF, Bagatim BQ, Mendes AM, Rotta I, Reis RC, Fávero MLD, Fernandez-Llimós F, Pontarolo R. Impact of discharge medication counseling in the cardiology unit of a tertiary hospital in Brazil: A randomized controlled trial. Clinics (Sao Paulo) 2018; 73:e325. [PMID: 29723341 PMCID: PMC5902758 DOI: 10.6061/clinics/2018/e325] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge. METHODS This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge. RESULTS Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05). CONCLUSIONS Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.
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Affiliation(s)
- Aline F. Bonetti
- Departamento de Farmacia, Universidade Federal do Parana, Curitiba, PR, Brasil
| | - Bruna Q. Bagatim
- Departamento de Farmacia, Universidade Federal do Parana, Curitiba, PR, Brasil
| | - Antonio M. Mendes
- Departamento de Farmacia, Universidade Federal do Parana, Curitiba, PR, Brasil
| | - Inajara Rotta
- Departamento de Farmacia, Universidade Federal do Parana, Curitiba, PR, Brasil
| | - Renata C. Reis
- Departamento de Farmacia, Universidade Federal do Parana, Curitiba, PR, Brasil
| | | | - Fernando Fernandez-Llimós
- Departamento de Socio-Farmacia, Instituto de Pesquisa de Medicamentos (iMed. Ulisboa), Faculdade de Farmacia, Universidade de Lisboa, Lisboa, Portugal
| | - Roberto Pontarolo
- Departamento de Farmacia, Universidade Federal do Parana, Curitiba, PR, Brasil
- *Corresponding author. E-mail:
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Feldman JD, Otting RI, Otting CM, Witry MJ. A community pharmacist–led service to facilitate care transitions and reduce hospital readmissions. J Am Pharm Assoc (2003) 2018; 58:36-43. [DOI: 10.1016/j.japh.2017.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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Ferrandino R, Roof S, Ma Y, Chan L, Poojary P, Saha A, Chauhan K, Coca SG, Nadkarni GN, Teng MS. Unplanned 30-Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis. Otolaryngol Head Neck Surg 2017; 157:955-965. [PMID: 28949797 DOI: 10.1177/0194599817721154] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To examine rates of readmission after parathyroidectomy in patients with chronic kidney disease and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in patients with chronic kidney disease between January 2013 and November 2013. Patient-, admission-, and hospital-level characteristics were compared for patients with and without at least 1 unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the 30 days after discharge, but readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5 to 6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% confidence interval [CI], 1.55-7.05; P = .002) and 1.87 (95% CI, 1.10-3.19; P = .02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR, 2.53; 95% CI, 1.07-5.95; P = .03) were associated with higher risk of readmission. Conclusion Postparathyroidectomy readmission rates for patients with chronic kidney disease are nearly 5 times that of the general population. Careful consideration of postoperative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.
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Affiliation(s)
- Rocco Ferrandino
- 1 Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott Roof
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yue Ma
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lili Chan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Priti Poojary
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Aparna Saha
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kinsuk Chauhan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Steven G Coca
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Girish N Nadkarni
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Marita S Teng
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Van Gorder CM, Yost SH, Negrelli JM, Anderson SH, Chew C. Effective Decentralization of a Pharmacy Technician to Facilitate Delivery of Medications Prior to Discharge in a Community Hospital. J Pharm Technol 2017; 33:123-127. [PMID: 34860882 DOI: 10.1177/8755122517705398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There are many benefits to a well-designed prescription process and delivery service at the time of discharge from the hospital. However, the discharge prescription delivery service in our hospital has historically been infrequently utilized. Objective: To assess the number of patients with prescriptions in hand prior to discharge, the number of prescriptions filled, the duration of time to get discharge prescriptions to the floor, and the motivation patients had for declining the service. Methods: This single-center, quality improvement project was initiated as a pilot program from March through December 2015, utilizing a certified pharmacy technician (CPhT) on a 56-bed cardiovascular floor from Monday through Friday, 9:00 am to 5:30 pm. All patients discharged during the pilot time period were included in the analysis. The CPhT was responsible for collecting, inputting, processing, delivering, and charging for discharge prescriptions. Results: The number of patients utilizing the service increased from an average of 68 to 132 per month, pre- and postintervention, respectively. Total prescriptions increased from 296 preintervention to 456 postintervention per month. Prescription delivery time to the patient was decreased by 28 minutes. Conclusions: The utilization of a decentralized CPhT in a 56-bed cardiology unit at a large community hospital increased both the number of patients and total number of prescriptions filled prior to discharge. Future studies are warranted to evaluate medication interventions at discharge and readmission rates in patients who have prescriptions in hand prior to discharge versus those that do not.
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Rodrigues CR, Harrington AR, Murdock N, Holmes JT, Borzadek EZ, Calabro K, Martin J, Slack MK. Effect of Pharmacy-Supported Transition-of-Care Interventions on 30-Day Readmissions: A Systematic Review and Meta-analysis. Ann Pharmacother 2017; 51:866-889. [DOI: 10.1177/1060028017712725] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To describe pharmacy-supported transition-of-care (TOC) interventions and determine their effect on 30-day all-cause readmissions. Data Sources: MEDLINE/PubMed, EMBASE, International Pharmaceutical Abstracts, ABI Inform Complete, PsychINFO, Web of Science, Academic Search Complete, CINHAL, Cochrane library, OIASTER, ProQuest Dissertations & Theses, ClinicalTrials.gov , and relevant websites were searched from January 1, 1995, to December 31, 2015. Study Selection and Data Extraction: PICOS+E criteria were utilized. Eligible studies reported pharmacy-supported TOC interventions compared with usual care in adult patients discharged to home within the United States. Studies were required to evaluate postdischarge outcomes (eg, rate of readmissions, hospital utilization). Randomized controlled trials, cohort studies, or controlled before-and-after studies were included. Two reviewers independently extracted data and evaluated study quality. Data Synthesis: A total of 56 articles were included in the systematic review (n = 61 858), of which 32 reported 30-day all-cause readmissions and were included in the meta-analysis. A taxonomy was developed to categorize targeted patients, intervention types, and pharmacy personnel as sole intervener. The meta-analysis demonstrated about a 32% reduction in the odds of readmission (odds ratio [OR] = 0.68; 95% CI = 0.61 to 0.75) observed for pharmacy-supported TOC interventions compared with usual care. Heterogeneity was identified ( I2 = 55%; P < 0.001). A stratified meta-analysis showed that interventions with patient-centered follow-up reduced 30-day readmissions relative to studies without follow-up (OR = 0.70; CI = 0.63 to 0.78). Conclusions: Pharmacy-supported TOC programs were associated with a significant reduction in the odds of 30-day readmissions.
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Joseph T, Barros RA, Kim E, Shah B. Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits. J Pharm Pract 2017; 31:279-283. [PMID: 28539101 DOI: 10.1177/0897190017710525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. OBJECTIVE The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. METHODS In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. RESULTS One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). CONCLUSION Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.
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Affiliation(s)
- Tina Joseph
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | | | - Elise Kim
- 3 Department of Pharmacotherapy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Bupendra Shah
- 4 Department of Social Administrative Sciences, Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
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Bailey JE, Surbhi S, Bell PC, Jones AM, Rashed S, Ugwueke MO. SafeMed: Using pharmacy technicians in a novel role as community health workers to improve transitions of care. J Am Pharm Assoc (2003) 2017; 56:73-81. [PMID: 26802925 DOI: 10.1016/j.japh.2015.11.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/27/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the design, implementation, and early experience of the SafeMed program, which uses certified pharmacy technicians in a novel expanded role as community health workers (CPhT-CHWs) to improve transitions of care. SETTING A large nonprofit health care system serving the major medically underserved areas and geographic hotspots for readmissions in Memphis, TN. PRACTICE INNOVATION The SafeMed program is a care transitions program with an emphasis on medication management designed to use low-cost health workers to improve transitions of care from hospital to home for superutilizing patients with multiple chronic conditions and polypharmacy. EVALUATION CPhT-CHWs were given primary responsibility for patient outreach after hospital discharge with the use of home visits and telephone follow-up. SafeMed program CPhT-CHWs served as pharmacist extenders, obtaining medication histories, assisting in medication reconciliation and identification of potential drug therapy problems (DTPs), and reinforcing medication education previously provided by the pharmacist per protocol. RESULTS CPhT-CHW training included patient communication skills, motivational interviewing, medication history taking, teach-back techniques, drug disposal practices, and basic disease management. Some CPhT-CHWs experienced difficulties adjusting to an expanded scope of practice. Nonetheless, once the Tennessee Board of Pharmacy affirmed that envisioned SafeMed CPhT-CHW roles were consistent with Board rules, additional responsibilities were added for CPhT-CHWs to enhance their effectiveness. Patient outreach teams including CPhT-CHWs achieved increases in home visit and telephone follow-up rates and were successful in helping identify potential DTPs. CONCLUSION The early experience of the SafeMed program demonstrates that CPhT-CHWs are well suited for novel expanded roles to improve care transitions for superutilizing populations. CPhT-CHWs can identify and report potential DTPs to the pharmacist to help target medication therapy management. Critical success factors include strong CPhT-CHW patient-centered communication skills and strong pharmacist champions. In collaboration with state pharmacy boards and pharmacist associations, the SafeMed CPhT-CHW model can be successfully scaled to serve superutilizing patients throughout the country.
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Medication discrepancy rates among Medicaid recipients at hospital discharge. J Am Pharm Assoc (2003) 2017; 57:488-492. [PMID: 28495145 DOI: 10.1016/j.japh.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 01/04/2017] [Accepted: 03/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare the rate of discrepancies per patient for medications changed during hospitalization in patients with and without prescription provider comments at hospital discharge. Secondary objectives included comparing 35-day readmission rates, describing the overall medication discrepancy rate stratified by age group and type of discrepancy, collecting average number of medication changes, and reporting percentage change in admission medications at discharge. METHODS This single-center prospective cohort included NC Medicaid recipients discharged from East Carolina University Family Medicine service from November 1, 2015, to January 31, 2016. Patients were assigned to a group based on presence or absence of provider comments on discharge prescriptions. Outpatient pharmacy claims were compared with the discharge summary to identify medication discrepancies. Medication discrepancy rates between groups were to be compared by means of independent-samples t test. Medication discrepancy rates were compared according to 35-day readmission status, age group, and type of discrepancy by means of independent-samples t tests and analysis of variance. Descriptive statistics were used for other secondary outcomes. RESULTS Of 118 patients included, only 1 had provider comments. Therefore, a medication discrepancy rate comparison was not performed. Patients had a mean of 4 medication changes made to their regimen and 21.3% change in admission medications. Sixty-one percent of patients had at least 1 medication discrepancy, with an overall rate of 1.19. Patients readmitted within 35 days had a significantly greater medication discrepancy rate than those not readmitted (1.63 vs. 1.05, respectively; P = 0.044). Patients 18-49 years of age had the highest discrepancy rate and those older than 80 years of age the lowest (1.58 and 0.50, respectively). New or changed discharge medication not filled accounted for 69% of discrepancies. CONCLUSION Although medication discrepancies were common, use of provider comments was rare. Future studies should address more effective ways to communicate pertinent information to community pharmacists and methods to improve adherence in obtaining new medications.
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Nuffer W, Gilliam E, Thompson M, Vande Griend J. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2017; 81:36. [PMID: 28381896 PMCID: PMC5374925 DOI: 10.5688/ajpe81236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/03/2016] [Indexed: 05/30/2023]
Abstract
Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students' self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services.
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Rafferty A, Denslow S, Michalets EL. Pharmacist-Provided Medication Management in Interdisciplinary Transitions in a Community Hospital (PMIT). Ann Pharmacother 2016; 50:649-55. [PMID: 27273678 DOI: 10.1177/1060028016653139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Medication management during transitions of care (TOC) impacts clinical outcomes. Published literature on TOC implementation is increasing, but data remains limited regarding the optimal role for the inpatient pharmacist, particularly in the community health setting. OBJECTIVE To evaluate the impact of a dedicated inpatient TOC pharmacist on re-presentations following discharge. METHODS This is a prospective study with historical control. All adult patients discharging home from study units were eligible. The TOC pharmacist (1) reviewed medication history and admission reconciliation, (2) met the patient/caregiver to assess barriers, (3) reviewed discharge reconciliation, (4) performed discharge education, and (5) communicated with next level of care. The primary outcome was 30 day re-presentation rate. Secondary outcomes included 60, 90, and 365 day re-presentation rates. IRB approval was obtained. RESULTS Three hundred and eighty four patients met inclusion criteria. When compared to 1,221 control patients, the intervention had an 11% absolute and 50.2% relative reduction in 30 day re-presentation rate (OR 0.43, 95% CI 0.30-0.61, NNT 9). Reductions in re-presentations at 60, 90 and 365 days remained statistically significant. Utilization avoidance was $786,347. For every $1 invested in pharmacist time, $12 was saved. The TOC pharmacist made a total of 904 interventions (mean 2.4 per patient). CONCLUSION This study provides new information from previous studies and represents the largest study with significant and sustained reductions in re-presentations. Integrating a pharmacist into an interdisciplinary team for medication management during TOC in a community health system is beneficial for patients and financially favorable for the institution.
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Affiliation(s)
- Aubrie Rafferty
- Mission Hospital and UNC Eshelman School of Pharmacy, Asheville Campus; Asheville, NC, USA
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Shcherbakova N, Tereso G. Clinical pharmacist home visits and 30-day readmissions in Medicare Advantage beneficiaries. J Eval Clin Pract 2016; 22:363-8. [PMID: 26695700 DOI: 10.1111/jep.12495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS & OBJECTIVES A variety of transition of care interventions has been evaluated to date to reduce readmissions. No studies evaluated effectiveness of clinical pharmacist's home-visits to recently discharged Medicare Advantage patients with the goal of preventing subsequent readmissions and urgent care use. The objective of this study was to evaluate the effectiveness of in-home clinical pharmacist's transition of care program on 30-day all-cause readmissions, emergency department (ED) visits, outpatient visits, as well as to assess patient satisfaction with the program. METHODS The study used retrospective cohort design. RESULTS A total of 245 patients were included in the study (mean (SD) age 77.8 (8.7); mean Charlson's Comorbidity Index 5.0 (2.5); 53.5% male). Forty-seven patients (19.0%) experienced at least one ED visit and twenty-two patients (9.0%) were readmitted within 30 days. The two groups did not differ on available demographic and clinical characteristics (p > 0.05). There was no difference in 30-day readmission rates, percent of patients with ≥1 ED visit, ≥1 outpatient physician office visit between the groups (p > 0.05). A total of 78 program participants responded to a satisfaction survey with 95% agreeing the program helped to stay healthy at home. CONCLUSION Multiple medication-related problems were identified by in-home pharmacists and the program appeared to be well-accepted by participants. In this study we did not find that the program had an impact on reduction of inpatient or urgent healthcare use. Further research using a different study design and a larger sample to estimate the program effectiveness is warranted.
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Affiliation(s)
| | - Gary Tereso
- Health New England, Inc, Springfield, MA, USA
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Budiman T, Snodgrass K, Komatsu Chang A. Evaluation of Pharmacist Medication Education and Post-discharge Follow-up in Reducing Readmissions in Patients With ST-Segment Elevation Myocardial Infarction (STEMI). Ann Pharmacother 2015; 50:118-24. [DOI: 10.1177/1060028015620425] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hospital readmissions have been shown to contribute to both patient morbidity and rising health care expenditures across a number of disease processes. Adherence to a cardioprotective drug regimen is particularly important after ST-segment elevated myocardial infarction (STEMI) because it is an acute condition associated with high patient morbidity and mortality. Objective: The objective of this study was to evaluate the effectiveness of pharmacist intervention with regard to reduction in hospital readmissions and improvement in medication adherence and literacy. Methods: This was a prospective single-center study in which patients admitted with STEMI who received stents between January 2015 and April 2015 were included. Pharmacist intervention included medication reconciliation, medication education, facilitation of the delivery of discharge medications, and post-discharge telephone calls within 48 to 72 hours. A retrospective review of historical STEMI patients who did not have pharmacist transitions of care support was performed to compare readmission rates. Results: All-cause readmission at 30 days decreased from 13% to 5% ( P = 0.18). Twelve of 95 patients in the historical control group were readmitted, compared to 2 of 40 patients in the intervention group. In the historical group, 3 of 12 patients required subsequent stent placement upon readmission, compared to none in the intervention group., Medication adherence and literacy scores improved significantly from baseline to high adherence and literacy at 30 days post-discharge ( P = 0.0005). Conclusion: Pharmacist involvement in medication education signficantly improved medication adherence and literacy. There was a reduction in 30-day readmission rates, but the results were not statistically significant.
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Chevalier BAM, Watson BM, Barras MA, Cottrell WN. Hospital pharmacists' perceptions of medication counseling: A focus group study. Res Social Adm Pharm 2015; 12:756-71. [PMID: 26626591 DOI: 10.1016/j.sapharm.2015.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medication counseling sessions are key times for a pharmacist to speak to patients about their medications and the changes made to their therapies during their hospital stay. OBJECTIVES To explore hospital pharmacists' perceptions of their roles and goals in patient medication counseling, and perceived barriers and facilitators to achieving their goals. METHODS Hospital pharmacist focus groups were held in two tertiary referral hospitals. Eligible pharmacists had provided medication counseling within the previous six months in inpatient and/or outpatient settings. Interested pharmacists attended a focus group designed to elicit their opinions and perceptions of patient medication counseling. Focus groups were audio recorded and transcribed verbatim. Inductive thematic analysis was applied to the data to identify initial patterns (codes) which were then organized into common overarching themes using NVivo(®) software. The codes were reviewed for reliability by pharmacists independent of the focus groups. RESULTS Six, 1-h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was determined after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. A number of themes emerged from these codes around the goals, roles, and the barriers and facilitators to meeting these goals. Pharmacists' patient-centered goals in medication counseling were to build rapport, to empower patients and to improve patients' experience, health and safety. These goals would be accomplished through specific roles such as being an assessor, educator and problem-solver. Pharmacists frequently cited time pressures caused by systemic (hospital), and pharmacy specific processes as key challenges to achieving their goals. Factors that enabled pharmacists to meet their goals were those related to effective interprofessional collaboration and the quality of professional practice (such as training, expanded roles and advanced planning for discharge). CONCLUSIONS Hospital pharmacists emphasized patient-centered goals in medication counseling and outlined the challenges to meet those goals. The findings from this study will be used to develop strategies for effective communication and inform pharmacy practice changes to improve patient care.
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Affiliation(s)
- Bernadette A M Chevalier
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall St, Woolloongabba, QLD 4102, Australia.
| | - Bernadette M Watson
- School of Psychology, The University of Queensland, Room 408, McElwain Building, St. Lucia, QLD 4072, Australia
| | - Michael A Barras
- Pharmacy Department, Royal Brisbane and Woman's Hospital, Butterfield St, Herston, QLD 4029, Australia
| | - William Neil Cottrell
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
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Sanchez GM, Douglass MA, Mancuso MA. Revisiting Project Re-Engineered Discharge (RED): The Impact of a Pharmacist Telephone Intervention on Hospital Readmission Rates. Pharmacotherapy 2015; 35:805-12. [DOI: 10.1002/phar.1630] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Gail M. Sanchez
- Department of Pharmacy; Boston Medical Center; Boston Massachusetts
| | - Mark A. Douglass
- Department of Pharmacy; Boston Medical Center; Boston Massachusetts
- Department of Pharmacy Practice; Northeastern University; Boston Massachusetts
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Lisenby KM, Carroll DN, Pinner NA. Evaluation of a Pharmacist-Specific Intervention on 30-Day Readmission Rates for High-Risk Patients with Pneumonia. Hosp Pharm 2015; 50:700-9. [PMID: 26823619 PMCID: PMC4686476 DOI: 10.1310/hpj5008-700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pharmacist interventions have been shown to have an impact on reducing readmission rates, however further research is necessary to target resources to high-risk populations and determine the most effective bundle of interventions. OBJECTIVE To evaluate the effect of a pharmacist-bundled intervention on 30-day readmission rates for high-risk patients with pneumonia. METHODS A pilot study with a historical control conducted at a community, teaching-affiliated medical center. Up to 65 selected subjects were included if they had pneumonia and any of the following high-risk criteria: admission within 6 months, at least 5 scheduled home medications, chronic obstructive pulmonary disease (COPD), or heart failure. A retrospective chart review was conducted to compile the historical control group that received usual care between June and November 2013. Patients admitted from December 2013 through March 2014 were reviewed to receive a bundled intervention. The primary outcome was 30-day readmission rates. Risk factors and reasons for readmission, pharmacist clinical interventions, and the time interval between discharge and readmission were also evaluated. RESULTS A trend toward a reduced 30-day readmission rate was observed in the intervention group (n = 43) compared to those who received usual care (n = 65) (27.9% vs 40.0%; relative risk [RR], 0.6977; 95% CI, 0.3965-1.2278; P = .2119). The most commonly identified high-risk inclusion criteria were having at least 5 scheduled home medications and COPD. The time interval between discharge and readmission did not considerably differ between groups (10.8 vs 10.6 days). CONCLUSIONS The pharmacist-bundled intervention was associated with a reduced 30-day readmission rate for high-risk patients with pneumonia.
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Affiliation(s)
- Katelin M. Lisenby
- Assistant Clinical Professor, Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, Alabama
- Assistant Clinical Professor, Department of Family Medicine, University of Alabama College of Community Health Sciences, University Medical Center, Tuscaloosa, Alabama
| | - Douglas N. Carroll
- Internal Medicine Clinician and PGY1 Residency Program Director, DCH Regional Medical Center, Tuscaloosa, Alabama.
| | - Nathan A. Pinner
- Assistant Clinical Professor, Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, Alabama
- Assistant Clinical Professor, Department of Family Medicine, University of Alabama College of Community Health Sciences, University Medical Center, Tuscaloosa, Alabama
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