Ensuring continuity of patient care across the healthcare interface: Telephone follow‐up post‐hospitalization

Abstract

AIMSTo implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group. METHODPragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service. RESULTSUsing an intention to treat approach, reductions in 30-and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio = 0.57; 95% confidence interval (CI): 0.36-0.90; P < 0.001] and 15.2% (odds ratio = 0.53; 95% CI: 0.36-0.79; P = 0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9-74.9) for intervention group compared with 60.1 days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs. 6.7 days; P < 0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to À2.27; P < 0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P < 0.001). Most patients (83.8%) reported having better control of their medicines after the intervention. CONCLUSIONS Pharmacist-led postdischarge structured TFU intervention can reduce 30-and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction. British Journal of Clinical Pharmacology Br J Clin Pharmacol (2019) 85 616-625 616• Telephone follow-up (TFU) is a well-established and widely used approach for exchanging information with patients. It has been applied in continuity of care after hospitalization. • Mixed results have been reported when TFU was combined with predischarge and other postdischarge interventions. WHAT THIS STUDY ADDS• This study applied the Perceptions and Practicalities Approach, endorsed by the National Institute for Health and CareExcellence Medicines Guidelines, to tailor medication support to meet the needs of the individual. • We utilized propensity score matching to obtain a well-matched control group, to determine the impact of a pharmacistled postdischarge telephone intervention on readmission rate. • This is the first study to present the benefit-cost ratio of the impact of TFU on readmission rate. Continuityof patient care post-hospitalisation Br J Clin Pharmacol (2019) 85 616-625 617 Continuity of patient care post-hospitalisation Br J Clin Pharmacol (2019) 85 616-625 623

A novel approach to medicines optimisation post-discharge from hospital: pharmacist-led medicines optimisation clinic

“…This is the second proposed model of post-discharge care put forward by this research team; the other being a post-discharge telephone follow-up [ 40 ]. The need for both services exist because some patient/problems need a face-to-face interaction in order that an appropriate solution can be achieved.…”

General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

“…In addition, significant medication wastage has been found within general practice settings in England with an estimated £300 million worth of prescribed medications being wasted each year in primary and community care [11]. Optimisation of drug therapy and prevention of MRPs therefore has the potential to reduce health care expenditure, increase patient quality of life and save lives [12][13][14][15].…”

Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

“…It is already known that care transitions lead to an increased risk of medication errors that can result in adverse events, prolonged hospital admissions, earlier readmissions, and overutilization of health care resources [11]. While pharmacist intervention during and after hospitalization has been frequently studied in the areas of medication reconciliation and discharge counseling, or on the use of a follow-up phone call, this is one of the few studies that have assessed medication adherence post-discharge in a program that includes all of these factors alongside bedside delivery of medications [12,13,14,15,16,17,18,19].…”