Pharmacist-Driven Intervention Program Reduces Readmissions

A pharmacist-driven intervention program can reduce readmissions, according to a study published in the American Journal of Health-System Pharmacy.

Rates of 30-day readmissions were substantially lower with pharmacist involvement and collaboration with other healthcare team members during patient transitions from the hospital to home, according to the study.

Deborah Hauser, RPh, MHA, network director of pharmacy, outpatient pharmacy, Einstein Medical Center, and her colleagues conducted a quality-improvement cohort study of 1,059 admissions of 667 patients at an inner-city hospital. Einstein is the largest independent academic medical center in the Philadelphia area.

The study compared rates of unplanned readmissions within 30 days of discharge in the full- and partial-intervention groups and in patients who received standard discharge care.

Among patients who received the full intervention, 30 of 305 admissions (9.8%) resulted in unplanned readmissions within 30 days, compared with a readmission rate of 20.4% (110 of 538 patients) among patients who received standard discharge care.

The findings demonstrate the role and value of pharmacists in reducing hospital readmissions using a standard intervention that includes medication reconciliation, patient-centered education, resolution of access-to-care issues, and follow-up counseling and communication with healthcare providers, says Hauser.

“When a pharmacist is deployed with a structured intervention as a part of the multidisciplinary discharge process, readmissions can be reduced,” she says. “This study was conducted as a quality improvement program to improve hospital readmissions.”

Patients in the intervention groups received some or all components of Einstein’s multifaceted “Medication REACH” intervention, which includes:

• Reconciliation of the patients’ medication lists making sure they are accurate and complete at discharge. At this step, the pharmacist contacts the prescriber to optimize therapy and clarify any medications for safety and accuracy.

• Patient-centered education by the pharmacist.

• Access, where the pharmacist works closely to ensure the patient has access to medications through insurance and assists with prior authorizations or therapy changes to formulary products. “Many patients were able to gain access through our discharge pharmacy, so medications are readily available at discharge,” Hauser says.

• Counseling, with post-discharge follow-up phone calls, which can be done by a delegate or pharmacy personnel. “In our study, we teamed with the Philadelphia Corporation for Aging and had a bridge coordinator who did visits to homes and calls,” Hauser says. “The pharmacist is then deployed if further clarifications about medications are needed. Post-discharge counseling can reinforce medication adherence, verifying that patients are not experiencing any side effects and making sure the patient sees a primary care physician for follow up.”

• Healthy patient at home. “If the prior steps are fully implemented, we strive for a healthy patient at home, and not being readmitted,” Hauser says.

Pharmacists are best suited to review and optimize patient therapies to improve patient care outcomes, Hauser says. “Pharmacists play very close attention to medication details to ensure an optimal discharge for the patient as it pertains to medication therapy management beyond the hospital as part of a larger population health strategy.”

Pharmacists are often underutilized in hospitals, according to Hauser. “There is tremendous opportunity to improve the discharge process and continue to build on the use of pharmacists to improve medication therapy management beyond the hospital as part of a larger population health strategy.”

Einstein Medical Center is developing a role for pharmacists in an accountable care organization as a follow-up expansion to its current program.

Tracey Walker is content manager of Drug Topics’ sister publication, Managed Healthcare Executive