Background:Transitional care programs are a growing topic in health care systems across the country, with a focus on achieving a reduction in hospital readmissions and improving patient and medication safety. Numerous strategies have been employed and studied to determine successful approaches to patient transition from the hospital setting to the home setting. Pharmacist-mediated postdischarge telephonic outreach has demonstrated decreased hospital readmission rates in multiple hospital systems. Objective: To evaluate the effectiveness of pharmacist-facilitated telephonic medication therapy management (MTM) services on reducing hospital readmissions. Methods: A retrospective chart analysis (n = 314) was performed for patients who received MTM services following hospital discharge between February 23, 2014 and July 4, 2014. The primary outcome was 30-day all-cause readmission. The secondary outcomes were identification of pharmacist interventions for and recommendations about medication-related problems and discrepancies found between the patients' reported medication list and the hospital discharge medication list. Results: The data revealed no statistically significant difference in hospital readmission rates between the intervention and control groups (odds ratio,1.04; 95% CI, 0.68-1.60). Pharmacists intervened on 189 medication-related problems via facsimile to the prescriber (35.7% of charts), contacted prescribers by phone for 23 medication-related or health-related issues, and identified 823 medication list discrepancies (78.34% of charts). Conclusion: Although the provision of telephonic MTM services by pharmacists did not result in an improvement in the readmission rate during this study period, pharmacists were able to intervene on numerous medication-related problems and medication list discrepancies.

Purpose This report describes the growth and development of the Pharmacy Transitions of Care (PTOC) program at a Florida health system and examines its impact on 30-day readmission rates for Medicare core-measure patients. Summary BayCare Health System is a large not-for-profit community health system with 15 hospitals in central Florida. In 2015, the PTOC program was developed to integrate 2 pharmacists into the transitions-of-care space to reduce readmissions, enhance patient care, and improve medication safety. The PTOC program focuses on traditional Medicare beneficiaries 65 years of age or older with the goal of preventing 30-day readmissions. The service model includes integration of a pharmacist into the discharge medication reconciliation process, as well as postacute care telephonic follow-up. Data and outcomes have been carefully tracked since program inception and consistently demonstrate a reduction in 30-day readmissions, with a 63% relative risk reduction during the beginning phases of the program and a ratio of observed to expected readmissions of 0.77. As a result, in less than 3 years the PTOC program has grown from 2 to 23 pharmacists and is a key component of BayCare Health System’s patient care strategy. Conclusion Medication reconciliation, clinical interventions, and patient education by pharmacists after hospital discharge reduced 30-day readmission rates for Medicare core-measure patients across a large health system. The adaptability of this program to other health systems and hospitals of varying size to achieve similar outcomes is valuable to share with the profession.

No outside funding supported this research. The University of Florida (UF) Medication Therapy Management Communication and Care Center (MTMCCC) receives grant funding from the Agency for Health Care Administration (AHCA) for services. Roane and Hardin are currently employed by UF as faculty with their practice sites at the UF MTMCCC. Salo is currently employed at UF as a clinical pharmacist with her practice site at the UF MTMCCC. Miller is currently employed as a transition of care clinical pharmacist at St. Joseph's Hospital in Tampa, Florida. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Miller and Roane were primary contributors to study concept and design, along with Salo and Hardin. Miller and Roane took the lead in data collection, assisted by Salo and Hardin, and data interpretation was performed by all the authors. The manuscript was written by all the authors and revised primarily by Roane and Miller, along with Salo and Hardin.