Impact of a community pharmacy transitions-of-care program on 30-day readmission

Abstract

Objectives-The primary objective of this study was to evaluate the impact of a Transitions of Care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmission.Design, setting and participants-A transitions of care program in an outpatient pharmacy, driven primarily by student pharmacists, provided telephonic counseling to recently discharged patients. The calls were conducted within two to seven days post discharge, and focused on medication counseling and reconciliation, as well as promotion of a physician follow up visit. The goal of this program was to decrease hospital readmissions among patients discharged with a cardiovascular-related diagnosis. Patient specific information was recorded in a spreadsheet, including discharge diagnosis, and readmission diagnosis for those who returned to an inpatient facility within 30 days. This study was a retrospective chart review. Data was manually extracted from the program's data spreadsheet and the institution's electronic medical record for patients referred to the transitions of care program from June through November 2017. Patients discharged to hospice, prison, or a long-term care facility were excluded from analysis. Researchers collected information on patient demographics, diagnoses and readmissions. Data analyses were performed using SAS 9.4.Outcome measures-The primary outcome measure was 30-day all-cause readmission and the secondary measure was 30-day related readmission.

Evaluation of a “Meds‐to‐Beds” program on 30‐day hospital readmissions

“…Comer et al found that a program similar to our intervention delivered at a large health system significantly reduced 30‐day readmissions by 16% (OR 0.84; 95% CI 0.75‐0.93) among a population of 6057 intervention patients compared with 12 114 controls . Similarly, Shaver et al found a 67% decreased odds of all‐cause 30‐day readmissions (OR 0.33, 95% CI 0.22‐0.48) in their transitions of care program that included “meds‐to‐beds” as a component of the intervention . On the other hand, Lam and colleagues found that a “meds‐to‐beds” program was not independently associated with lower 30‐day readmissions (adjusted OR 0.91, 95% CI 0.79‐1.04) in a large retrospective cohort study in a tertiary care hospital .…”

“…Similarly, while the Lam study did not include a LACE score, the intervention group in our study had significantly fewer prior hospitalizations and less comorbidities than the control group. On the other hand, in the study by Shaver and colleagues, 55% of patients in the intervention group had a LACE score of 10 of greater, suggesting a higher overall risk for readmissions among their population …”

“…In the Lam study, while power was not discussed, their intervention group was 2252 and likely underpowered . The study by Comer et al found an absolute reduction of 1.5% for 30‐day readmissions among their population of 18 171 patients, whereas the study by Shaver and colleagues found a 10% reduction among their 1219 patients . The variability in the all‐cause readmission rates between these studies suggests that other population, geographic, or hospital specific characteristics may be important factors in determining the effectiveness of these programs.…”

Role of clinical pharmacists and pharmacy support personnel in transitions of care

“…Follow‐ups can provide a bridge from one care setting or provider to the next, an opportunity for clinical pharmacists to check that the patient is following the care plan conveyed at the time of discharge and triage any difficulties during the patient's care transition. These activities can be flexible as far as when, where, and who is providing the follow‐up contact and can incorporate CMM principles to identify, resolve, and prevent medication‐related problems . If timed appropriately, follow‐up activities by clinical pharmacists can support requirements for transitional care management (TCM) billing as part of a collaborative care team …”

“…These activities can be flexible as far as when, where, and who is providing the follow-up contact and can incorporate CMM principles to identify, resolve, and prevent medication-related problems. [17][18][19] If timed appropriately, follow-up activities by clinical pharmacists can support requirements for transitional care management (TCM) billing as part of a collaborative care team. [20][21][22] Interventions that focus on medication cost and acquisition can also reduce medication errors and readmissions.…”