Aiming Beyond: A Pharmacist Impact on 90-Day Readmissions and Clinical Outcomes Within a Family Medicine Service

Abstract

Previous studies have shown pharmacists positively impact 30-day readmission rates. However, there is limited data regarding the effect of clinical pharmacist (CP) follow-up on 90-day readmission or evaluation of disease-specific goals after hospitalization. Investigators analyzed the impact of postdischarge extended CP follow-up within a family medicine service (FMS). The primary end point was all-cause 90-day readmission rates. Secondary end points included all-cause 30- and 60-day readmission rates and the achievement of disease-specific goals postdischarge. Retrospective chart review was performed for patients admitted from August 2016 to November 2017 who were seen by a physician within the FMS 14 days postdischarge. Fourteen percent of patients within the CP intervention group were readmitted within 90 days in comparison to 22% in the standard of care group ( P = .244). Readmission rates at 30 and 60 days were as follows: intervention group 2%, 10%, and standard of care group 16%, 22% ( P = .015, P = .089, respectively). In addition, multiple patients with uncontrolled diabetes who completed CP visits upon hospital discharge met glycemic goals at the end of the study time period. Despite inclusion of the CP in postdischarge care, 90-day readmission rate remained unchanged.

Health interventions for the reduction of hospital readmission within 30 days in clinical patients: An integrative review

“…The individual factors involve aspects related to the patients and their health status (Tavares et al, 2020, Fischer et al, 2012, such as presence of chronic diseases, comorbidities, disease severity, socioeconomic status (Conner et al, 2020, Souza & Peixoto, 2017, and patient's adherence to the therapy (Oscalices et al, 2019). The organizational factors include inadequate management of the comorbidities during hospitalization, errors in medication use, and failures in communication and in the post-discharge followup (Wiegmann et al, 2020).…”

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review

“…Of the 617 full-text articles that were reviewed, 57 were included in the final analysis. Just over half of the studies (31/57) achieved a statistically significant improvement in at least one patient outcome, 24 , 28 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 most commonly readmission to hospital.

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“…The studies originated from eight different countries: one each from Brazil, 39 Denmark, 63 Ireland, 50 Northern Ireland, 51 and Vietnam 64 ; two studies were from the United Kingdom (UK) 65 , 66 ; three from China 61 , 62 , 67 ; and the remaining 47 were from the United States (US). 24 , 28 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 Study sample sizes ranged from 50 to 43,711 (median = 246.5). Study characteristics were tabulated ( Table 1a ) to describe study inclusion criteria, clinical pharmacist activities constituting intervention and the control or comparator group, as well as outcomes or conclusions with statistical results if available ( Table 1b ).…”

“…The 57 studies comprised of 14 RCTs, 39 , 43 , 44 , 51 , 54 , 57 , 61 , 62 , 63 , 64 , 67 , 72 , 74 , 77 and 43 non-randomised studies ( Table 1a ). 24 , 28 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 55 , 56 , 58 , 59 , 60 , 65 , 66 , 68 , 69 , 70 , 71 , 73 , 75 , 76 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 The non-randomised studies consisted of 11 retrospective pre-post or segmented time-series studies, 38 , 47 , 53 , 59 , 65...…”

“…Study interventions were classified into three clinic types ( Table 1a , Table 1b ): post-discharge clinic pharmacist review only (21/57), 24 , 36 , 43 , 44 , 46 , 50 , 51 , 52 , 53 , 55 , 64 , 66 , 71 , 73 , 74 , 75 , 79 , 80 , 84 , 87 , 89 inpatient clinical pharmacist service with post-discharge clinic pharmacist follow-up (23/57), 38 , 39 , 42 , 45 , 47 , 48 , 49 , 54 , 56 , 57 , 58 , 61 , 62 , 63 , 67 , 70 , 72 , 77 , 78 , 81 , 83 , 86 , 88 and post-discharge collaborative clinic (a clinic pharmacist with other health care professionals) (13/57). 28 , 35 , 37 , 40 , 41 , 59 , 60 , 65 , 68 , 69 , 76...…”