Cost‐consequence analysis evaluating multifaceted clinical pharmacist intervention targeting patient transitions of care from hospital to primary care

Abstract

Aims Drug‐related problems are a common complication in the transition from hospital to primary care and are associated with morbidity and increased health care costs. In this study, we evaluated the cost and consequences of a comprehensive pharmaceutical intervention compared with usual care, comprised of a medication review and patient interview before discharge and follow‐up for polypharmacy patients. Methods This economic evaluation was embedded within a randomized clinical trial. Patients were randomized to either the basic intervention group (n = 493) which received a medication review, the extended intervention group (n = 476) which received a medication review, discharge interview, and follow‐up, or the control group (n = 498) which received standard care. Total health care costs were estimated over a period of 180 days at individual patient level from a health sector perspective. Results The mean cost per patient was lower in the intervention groups (basic, €16 748; extended, €15 631) compared with the control group (€17 288), although these differences did not reach statistical significance. The costs of additional time used on medication reviews, patient interviews, and follow‐ups (€88) were outweighed by a decrease in costs of readmissions. The results of the clinical study favored the extended intervention group on clinical outcomes, with statistical significance on a composite of readmissions or emergency department visits within 180 days after inclusion (hazard ratio 0.77, 95% confidence interval 0.64‐0.93). Conclusions This comprehensive pharmaceutical intervention was not costly and positive effects were seen in the clinical outcomes, thereby reaching a decrease in total cost per patient on average. The results thus indicate that the intervention is cost‐effective and that the positive net effects can justify costs of the intervention.

A developmental evaluation of an intraprofessional Pharmacy Communication Partnership (PROMPT) to improve transitions in care from hospital to community: A mixed-methods study

“…While this component of the intervention was not evaluated in isolation, overall results from the trial demonstrated lower 30-and 180-day hospital readmission rates for patients who received extended pharmacist intervention. An economic evaluation of the intervention showed that costs incurred due to increased pharmacist follow up were offset by reduced readmission-related costs [22].…”

Quality measures of clinical pharmacy services during transitions of care

“…Comprehensive admission-to-postdischarge practice models have found that time spent providing specific services ranged from 41 to 171 minutes per patient. 13,23,28,30,126 Services providing one component of this continuum suggest that an admission medication review, discharge medication review, and postdischarge telephone call require 15, 16-20, and 24 minutes per patient, respectively. 12,21,29 Beyond calculating actual human resource costs for pharmacists, other cost variables may include a pharmacy technician's cost to cover a pharmacist's work while the pharmacist is completing the TOC service, training costs, and other human resource costs from support staff.…”

“…Many such structures to consider are outlined in publications on TOC services that transcend settings and connect the care to patient needs (Table 4; Appendix 3). 21,28,53,54,59,60,126 These include, but are not limited to, features of structures and workflows that support pharmacy services to achieve optimal patient use of pharmacy services, streamlined communication methods among clinicians, and enhanced patient engagement. When developing TOC services, considerations must include the resources and funding needed to operate sustainably.…”

“…The most‐studied metric evaluating TOC services in institutional settings is the total time spent providing the service 12,21,23,28‐30,125 . Comprehensive admission‐to‐postdischarge practice models have found that time spent providing specific services ranged from 41 to 171 minutes per patient 13,23,28,30,126 . Services providing one component of this continuum suggest that an admission medication review, discharge medication review, and postdischarge telephone call require 15, 16‐20, and 24 minutes per patient, respectively 12,21,29 .…”

Preventing medication‐related harm: Perfect is the enemy of the good

“…Importantly, their intervention was found to be cost-effective. 5 We agree that coordination of care, including promoting appropriate medication use, should largely reside in primary care. As stated above, this should also encompass reducing avoidable mediation-related harm.…”