The effect of a pharmacist-led multidisciplinary transitions-of-care pilot for patients at high risk of readmission

Jones, Christine; Anthony, Amanda; Klein, Matthew D.S.; Shakowski, Courtney; Smith, Hilary; Go, Amy; Perica, Katharine; Patel, Hemali; Pell, Jonathan; Pierce, Read

doi:10.1016/j.japh.2018.05.008

Cited by 16 publications

(31 citation statements)

References 21 publications

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“…Of the 60 studies included, 50.0% (n = 30) were randomized controlled trials, 28 , 29 , 33–36 , 39 , 43 , 45–47 , 50 , 53 , 54 , 61–64 , 68–74 , 76 , 80 , 83 , 84 , 86 23.3% (n = 14) were non-randomized trials, 30 , 31 , 37 , 40 , 48 , 49 , 51 , 56–58 , 60 , 75 , 77 , 78 11.7% (n = 7) were cohort studies, 27 , 42 , 52 , 59 , 66 , 67 , 79 8.3% (n = 5) were before-and-after studies, 32 , 41 , 55 , 81 , 82 5.0% (n = 3) were quasi-randomized trials, 38 , 44 , 85 and 1.7% (n = 1) were case-control studies. 65 The majority of studies (53.3%, n = 32/60) were conducted in the United States of America (USA).…”

Section: Resultsmentioning

confidence: 99%

Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review

Varghese¹,

S²,

Deng³

et al. 2022

PPA

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Purpose Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings. Methods Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer. Results A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers). Conclusion The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.

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Section: Resultsmentioning

confidence: 99%

Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review

Varghese¹,

S²,

Deng³

et al. 2022

PPA

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“…The total number of comorbidities appear to be a stronger predictor of the re-admission rates as opposed to the acute illness severity [28]–[30]. This increased number of comorbidities necessitates a care delivery that is both personalized and collaborative in order to effectively reduce 30-day re-admissions [31].…”

Section: Discussionmentioning

confidence: 99%

Effect of clinical pharmacist encounters in the transitional care clinic on 30-day re-admissions: A retrospective study

et al. 2019

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Hospitalized patients who meet specific criteria at discharge are referred to the transitional care clinic team consisting of a nurse practitioner and/or physician and a clinical pharmacist. In collaboration with the providers, the pharmacist reviews medications for appropriateness, assesses adherence, recommends medication changes and provides education. The purpose of this study was to measure the effect of an outpatient transitional care clinical pharmacist on 30-day re-admissions in an urban setting serving a population of low socioeconomic status. After receiving IRB approval, this single-center retrospective study analyzed records of 573 patient visits of which nearly 75% included a clinical pharmacist interaction. Rates of 30-day re-admissions were not statistically different among the two groups, however, it was found that each added co-morbidity significantly increased the patients' 30-day re-admission rate by 26%.

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“…37 Recently, ambulatory TOC services were shown to affect 30-day readmission rates, with relative reductions ranging from 28% to 62.7%. 37,[89][90][91][92][93][94] The Pharmacist Advancement of Transitions of Care to Home (PATCH) service included postdischarge telephone calls and face-to-face visits with a pharmacist and primary care provider, resulting in a 41% relative reduction in the composite end point of 30-day readmissions and ED visits. 95 Readmission reductions at 90 and 180 days after discharge have also been evaluated.…”

Section: Services Originating Within Ambulatory Care and Community Settingsmentioning

confidence: 99%

“…One ambulatory care study showed reductions in 7‐ and 14‐day readmissions from 4% to 0.8% and 9% to 5%, respectively, highlighting the pharmacist's value in the immediate postdischarge period 37 . Recently, ambulatory TOC services were shown to affect 30‐day readmission rates, with relative reductions ranging from 28% to 62.7% 37,89‐94 . The Pharmacist Advancement of Transitions of Care to Home (PATCH) service included postdischarge telephone calls and face‐to‐face visits with a pharmacist and primary care provider, resulting in a 41% relative reduction in the composite end point of 30‐day readmissions and ED visits 95 …”

Section: Quality Measures and Associated Metricsmentioning

confidence: 99%

Quality measures of clinical pharmacy services during transitions of care

King

Burkhardt

Rafferty

et al. 2021

J Am Coll Clin Pharm

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The impact of clinical pharmacy transitions of care (TOC) services on relevant quality measures (QMs) has been a major focus in the recent biomedical literature. The 2020 ACCP Transitions of Care Task Force was charged with updating a 2012 white paper that focused on process indicators of quality clinical pharmacy services during TOC. The Task Force extensively reviewed the recent literature and regulatory measures relevant to TOC services. Given the wide heterogeneity and apparent uncertainty in these measures, the Task Force identified a need to define broader groupings for QMs so that pharmacy TOC services could more be reliably compared across various institutions and practice settings. The Task Force recommends QMs for the processes used to identify, and ultimately resolve, medication discrepancies (QM‐1) and medication therapy problems (MTPs) (QM‐2). Although interventions through various processes can be used to resolve medication discrepancies and MTPs, the findings of these interventions are closely aligned with the major outcomes from these TOC services. Therefore, the Task Force strongly recommends that the successful resolution of medication discrepancies and MTPs be studied for their potential roles as intermediate, or surrogate, QMs (iQM‐1, iQM‐2, respectively) because these are most likely to directly influence or predict quality related to major outcomes from TOC services. In addition, three QMs related to major outcomes are recommended, which are consistent with the triple aim: QM‐3: Health Care Utilization (HCU), QM‐4: Satisfaction and Engagement, and QM‐5: Economics. QM‐3, QM‐4, and QM‐5 span patient‐centered outcomes to institutional, or clinician‐based, outcomes. Specific metrics used for each QM are recommended. In addition to highlighting confounding variables affecting findings in the recent literature, broader contextual considerations that may support TOC services or span multiple practice settings are summarized. Future studies must adopt standard QMs and seek to understand the potential of iQMs to accurately predict success within major patient‐centered and institutional outcomes.

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The effect of a pharmacist-led multidisciplinary transitions-of-care pilot for patients at high risk of readmission

Cited by 16 publications

References 21 publications

Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review

Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review

Effect of clinical pharmacist encounters in the transitional care clinic on 30-day re-admissions: A retrospective study

Quality measures of clinical pharmacy services during transitions of care

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