Greatest impact of pharmacist transition care seen in elderly

A care transition program for hospital patients with bedside delivery of postdischarge medications and follow-up calls by pharmacists shortly after discharge had the greatest impact on elderly patients, resulting in a lower likelihood of 30-day readmission, according to a report published May 1 in the American Journal of Health-System Pharmacy.

In a two-year retrospective cohort study, patients from one acute care hospital in the southeastern United States were asked if they wanted to participate in a care transition program. The other acute care hospital in the same hospital system offered usual care. There were 692 of 19,659 hospitalized patients who enrolled in the care transition program and received postdischarge medications at the bedside from a pharmacy technician or pharmacist from the community pharmacy on the hospital campus.

Within 24 hours after discharge, the hospital call center contacted all patients to ask if they had scheduled a follow-up with their primary care doctor. Those patients in the care transition program also received another phone call within 72 hours postdischarge to assess medication compliance, understanding of drug regimens, and to answer any other concerns.

Patients who enrolled in the transition care program were characterized as having fewer comorbidities, a shorter hospital stay, and primary insurance that was not Medicaid. In addition, they were, in general, younger patients and were less likely to be black or men.

“Participants in the intervention group had nearly a twofold decrease in the likelihood of readmission compared with the usual care group,” according to the authors from the Walgreen Co., DeKalb Medical Center, and National Health Service England.

“The program had a greater effect on patients who were age 65 years or older compared with younger patients (adjusted OR, 1.53 versus 6.05),” they said.

Besides age, other characteristics in the patient population, which were associated with readmission, were black race (adjusted OR, 1.24; 95% CI, 1.12-1.36), longer hospital stay (adjusted OR, 1.01; 95% CI, 1.00-1.02), Medicaid insurance (adjusted OR, 1.38; 95% CI, 1.22-1.56), month of discharge (adjusted OR, 1.02; 1.01-1.03), and greater number of conditions (adjusted OR, 1.12; 95% CI, 1.10-1.13).

“One of the aims of this research study was to determine if specific sub-groups might benefit more from this pharmacist-hospital care transition program than others,” explained senior author Bobby Clark, PhD, MS Pharm, Walgreens director of clinical outcomes and analytic services.

“Our results showed that although the combined usual care population (non-care transition group) had nearly twice of the odds for an unplanned 30-day hospital readmission than the care transition group, the usual care elderly population (ages ≥65years) had a six-fold increase in the odds of a 30-day readmission compared to the elderly care transition group. To achieve the greatest gains with limited funds, we suggest that hospitals and hospital systems target the most at risk sub-populations for care transition programs to reduce unplanned hospital readmissions,” Clark said.