Improvement in the medication reconciliation postdischarge quality measure after implementation of a pharmacist-run service

Rhinehart, Hannah E.; Snider, Melissa; James, Adrian L.; Blosser, Laurence

doi:10.1016/j.japh.2019.10.006

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…Baseline demographics and clinical characteristics were similar between groups with the exception of more patients having COPD and MI in the historical control group and more patients having PVD and metastatic cancer in the intervention group (Table 1). The Charlson Comorbidity Index was similar between groups, but the median (interquartile range [IQR]) LACE Index score was higher in the intervention group (9 [7][8][9][10][11][12] vs. 11 [9][10][11][12][13][14]; p < 0.0001). There was a significant difference in patient discharge disposition with a greater percentage of patients discharged to a skilled nursing facility in the intervention group "very significant," 71 (65.7%) were "significant," and 9 (8.3%) were "somewhat significant."…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacist-led discharge medication reconciliation has resulted in variable effects on hospital readmission previously. 8,[11][12][23][24][25][26] This may be due to small sample sizes in many of these other investigations. 21,[25][26][27] Our study population was larger (approximately double) than many of the studies that were unable to show a difference in hospital readmission, and the use of multivariable modeling to account and adjust for LACE index is a strength of our investigation.…”

Section: Discussionmentioning

confidence: 99%

“…This intervention may be viewed as simplistic as other studies have involved interventions including discharge pharmacist counseling, phone call follow-ups, patient visits, and so forth. 5,7,8,[13][14] However, a meta-analysis analyzing pharmacy-led medication reconciliation data determined that multi-faceted interventions, including patient counseling in addition to medication reconciliation, had no greater effect on the discrepancy rate compared with pharmacist-led medication reconciliation alone. 14 The use of a PGY-2 pharmacy resident and student pharmacists is worth noting as this Home medication lists are more accurate and complete when pharmacists complete the medication list in an inpatient setting compared with non-pharmacy personnel.…”

Section: Discussionmentioning

confidence: 99%

“…These studies have demonstrated higher rates of detecting medication‐related errors and a lower rate of preventable adverse drug events (ADEs) 30 days post hospital discharge 5–7 . Further studies including meta analyses evaluating clinical impact, namely re‐admission rates, have found increasingly promising, yet inconsistent, results 8–14 …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Further studies including meta analyses evaluating clinical impact, namely re-admission rates, have found increasingly promising, yet inconsistent, results. [8][9][10][11][12][13][14] The Centers for Medicare and Medicaid Services established the Hospital Readmissions Reduction Program (HRRP) to improve care transitions and prevent avoidable hospital readmissions. 15 The HRRP enforces reimbursement penalties from the Centers for Medicare and Medicaid Services for institutions with excess readmissions for diagnoses including acute coronary syndromes (ACS), heart failure (HF), chronic obstructive pulmonary disease, pneumonia, and elective total knee or hip replacement.…”

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confidence: 99%

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Impact of pharmacist‐led discharge medication reconciliation at an Academic Medical Center

Woodruff

Carden

Seyse

et al. 2023

J Am Coll Clin Pharm

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Prior studies evaluating the impact of pharmacist‐led discharge medication reconciliation have demonstrated higher rates of medication discrepancy detection and intervention with variable effects on hospital readmission. The purpose of this study was to evaluate the impact of a newly developed pharmacist‐led hospital discharge medication reconciliation process implemented with an interdisciplinary Internal Medicine Service. This was a retrospective, single‐center, pre‐post observational cohort study. Institutional review board approval was obtained. The primary end point was quantification and categorization of medication discrepancies identified on the hospital discharge medication list. Secondary end points included characterization of interventions made during the discharge medication reconciliation process, and 30‐day hospital readmission rates that were adjusted using a multivariable logistic regression model. A total of 144 patients were included in the pharmacist‐led discharge medication reconciliation intervention group and 144 patients were included in the historical control. There was a statistically significant four‐fold reduction in the number of medication discrepancies identified on discharge medication lists in the intervention group (77 vs. 18 in the historical control vs. intervention groups, respectively; p < 0.0001). When adjusted for length of stay (L), acuity of the admission (A), comorbidity of the patient (C), and emergency department use in the last 6 months (E) (LACE) index and age, the adjusted odds ratio (aOR) for 30‐day readmission was 0.51 (95% confidence interval: 0.27–0.95) in the intervention versus the historical control group. Implementation of an interdisciplinary pharmacist‐led discharge medication reconciliation program was associated with a significant reduction in medication discrepancies on the discharge medication list, as well as a reduction in the adjusted odds of 30‐day hospital readmission.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of pharmacist‐led discharge medication reconciliation at an Academic Medical Center

Woodruff

Carden

Seyse

et al. 2023

J Am Coll Clin Pharm

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Effect of pharmacy-led interventions during care transitions on patient hospital readmission: A systematic review

Harris¹,

Moore²,

Barnes³

et al. 2022

Journal of the American Pharmacists Association

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A new perspective: Practice-enhancing publications about the medication-use process in ambulatory care in 2020

Gazda

Vest

Peek

et al. 2022

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This article identifies, prioritizes, and summarizes published literature on the ambulatory care medication-use process (ACMUP) from calendar year 2020 that can impact ambulatory pharmacy practice. Summary The medication-use process is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing and collaborative practice, accessing care, adherence, and monitoring and quality. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. A PubMed search covering calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 9,433 articles. A thorough review identified 65 potentially practice-enhancing articles: 14 for transitions of care, 19 for prescribing and collaborative practice, 10 for adherence, 6 for accessing care, and 16 for monitoring and quality. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why each article is important. The other articles are listed for further review and evaluation. Conclusion It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article is the first to define and evaluate the currently published literature pertinent to the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

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Improvement in the medication reconciliation postdischarge quality measure after implementation of a pharmacist-run service

Cited by 4 publications

References 10 publications

Impact of pharmacist‐led discharge medication reconciliation at an Academic Medical Center

Impact of pharmacist‐led discharge medication reconciliation at an Academic Medical Center

Effect of pharmacy-led interventions during care transitions on patient hospital readmission: A systematic review

A new perspective: Practice-enhancing publications about the medication-use process in ambulatory care in 2020

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