Effect of a care transition intervention by pharmacists: an RCT

Abstract

BackgroundPharmacists may improve medication-related outcomes during transitions of care. The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager (PCM) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events, rehospitalization and emergency department visits.MethodsDesign. Randomized, controlled trial of 945 participants assigned to enhanced, minimal and usual care groups conducted 2007 to 2012. Subjects. Participants with cardiovascular-related conditions and/or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine, family medicine, cardiology or orthopedics. Intervention. The minimal group received admission history, medication reconciliation, patient education, discharge medication list and medication recommendations to inpatient team. The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge. Participants were followed for 90 days post-discharge. Main Outcomes and Measures. Medication appropriateness index (MAI), adverse events, adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression, as models accommodating random effects due to pharmacists indicated little clustering.ResultsStudy groups were similar at baseline and the intervention fidelity was high. There were no statistically significant differences by study group in medication appropriateness, adverse events or adverse drug events at discharge, 30-day and 90-day post-discharge. The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days, and this was true across all study groups. Post-discharge, about 16% of all participants experienced an adverse event, and this did not differ by study group (p > 0.05). Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge, where 15% of all participants had a 30-day readmission. Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group.ConclusionThe pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups.Trial registrationClinicaltrials.gov registration: NCT00513903, August 7, 2007.

Case management effectiveness in reducing hospital use: a systematic review

“…Ten RCTs met the inclusion criteria and were extracted for final review for this systematic review (Chow & Wong ; Farris et al. ; Gary et al. ; Latour et al.…”

“…For sample sizes, calculation of power analysis was reported in four of the studies (Chow & Wong ; Farris et al. ; Latour et al. ; Sandberg et al.…”

“…In Farris et al. (), pharmacist CM was implemented to ensure medication adherence and reconciliation with participants who had cardiovascular or chronic pulmonary disorders. For Gary et al.…”

Bridging the gap between hospital and primary care: the pharmacist home visit

“…The acceptance by physicians of drug-related recommendations will require more intense communication than solely faxing a document to the physician's office [23]. Direct contact and intensive collaboration between community pharmacists and physicians may improve uptake of the recommendations given by the pharmacist [24].…”

Should Hospital Pharmacists Provide Postdischarge Follow-Up Care to High-Risk Patients?

“…3,7 Some studies have indicated that postdischarge medication reviews by a pharmacist may improve outcomes in specific patient populations, 8,9 but other studies have shown no improvement in clinically important outcomes, health care utilization, adverse events, or adverse drug events among those who received enhanced care, including postdischarge follow-up by a pharmacist, relative to those who received standard seamless care at discharge. 10,11 Also, it is currently unclear what this follow-up care should encompass. Study interventions have often included patient education and communication to primary care providers at discharge, in addition to a telephone call by a pharmacist after discharge.…”