The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization

Pevnick, Joshua M; Keller, Michelle S.; Kennelty, Korey A.; Nuckols, Teryl K.; Ko, EunJi Michelle; Amer, Kallie; Armbruster, Christine; Conti, Nicole; Fanikos, John; Guan, James; Knight, Emmanuel; Leang, Donna W.; Llamas-Sandoval, Ruby; Matta, Lina; Moriarty, Dylan; Murry, Logan T.; Muske, Anne Marie; Nguyen, An; Phung, Emily; Rosen, Olga; Rosen, Sonja; Salandanan, Audrienne; Shane, Rita; Schnipper, Jeffrey L.

doi:10.1016/j.cct.2021.106419

Cited by 11 publications

(10 citation statements)

References 32 publications

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“…We report this cost analysis in accordance with the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement. 18 This study occurred in the context of a pragmatic randomized controlled trial examining the effectiveness of these practices at reducing 30-day post-discharge hospital utilization 19 (PHARMacist Discharge Care (PHARM-DC) trial, clinicaltrials.gov (NCT04071951). 20 …”

Section: Methodsmentioning

confidence: 99%

Comprehensive Pharmacist-led Transitions-of-care Medication Management around Hospital Discharge Adds Modest Cost Relative to Usual Care: Time-and-Motion Cost Analysis

Nuckols,

Berdahl,

Henreid

et al. 2023

INQUIRY

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Optimal medication management is important during hospitalization and at discharge because post-discharge adverse drug events (ADEs) are common, often preventable, and contribute to patient harms, healthcare utilization, and costs. Conduct a cost analysis of a comprehensive pharmacist-led transitions-of-care medication management intervention for older adults during and after hospital discharge. Twelve intervention components addressed medication reconciliation, medication review, and medication adherence. Trained, experienced pharmacists delivered the intervention to older adults with chronic comorbidities at 2 large U.S. academic centers. To quantify and categorize time spent on the intervention, we conducted a time-and-motion analysis of study pharmacists over 36 sequential workdays (14 519 min) involving 117 patients. For 40 patients’ hospitalizations, we observed all intervention activities. We used the median minutes spent and pharmacist wages nationally to calculate cost per hospitalization (2020 U.S. dollars) from the hospital perspective, relative to usual care. Pharmacists spent a median of 66.9 min per hospitalization (interquartile range 46.1-90.1), equating to $101 ($86 to $116 in sensitivity analyses). In unadjusted analyses, study site was associated with time spent (medians 111 and 51.8 min) while patient primary language, discharge disposition, number of outpatient medications, and patient age were not. In this cost analysis, comprehensive medication management around discharge cost about $101 per hospitalization, with variation across sites. This cost is at least an order of magnitude less than published costs associated with ADEs, hospital readmissions, or other interventions designed to reduce readmissions. Work is ongoing to assess the current intervention’s effectiveness.

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Section: Methodsmentioning

confidence: 99%

Comprehensive Pharmacist-led Transitions-of-care Medication Management around Hospital Discharge Adds Modest Cost Relative to Usual Care: Time-and-Motion Cost Analysis

Nuckols,

Berdahl,

Henreid

et al. 2023

INQUIRY

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“…The interventions components focused on four specific categories where inpatient pharmacists have the ability to mitigate post-discharge ADEs: medication discrepancies, medication adherence, side effect management, and medication regimen optimization. A full list of intervention components and categorization is included in Table 1 and the intervention is described in more detail elsewhere [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…A full list of intervention components and categorization is included in Table 1 and the intervention is described in more detail elsewhere [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…Control patients were not prevented from receiving additional pharmacy-led TOC services and support. Currently, the PHARM-DC intervention is undergoing formal evaluation in a dual cite PRCT, testing the effect of the intervention on rate of 30-day post-discharge readmission, observation stay, or emergency department visit [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…The PHARM-DC intervention is currently under evaluation in a pragmatic randomized controlled clinical trial (PRCT) with 1:1 randomization at the patient level at two large hospitals in the Western and Northeastern United States [ 18 ]. To understand facilitators and barriers to implementation and sustainability across and between sites, and to enable future successful dissemination of the intervention to other institutions and settings, we undertook a qualitative evaluation using methods informed by implementation science.…”

Section: Introductionmentioning

confidence: 99%

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A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework

Murry

Keller

Pevnick

et al. 2022

BMC Health Serv Res

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Introduction Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention. Methods Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding. Results In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention. Conclusion The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability. Trial registration NCT04071951.

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Medication review in hospitalised patients to reduce morbidity and mortality

Bülow

Clausen

Lundh

et al. 2023

Cochrane Database of Systematic Reviews

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The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization

Cited by 11 publications

References 32 publications

Comprehensive Pharmacist-led Transitions-of-care Medication Management around Hospital Discharge Adds Modest Cost Relative to Usual Care: Time-and-Motion Cost Analysis

Comprehensive Pharmacist-led Transitions-of-care Medication Management around Hospital Discharge Adds Modest Cost Relative to Usual Care: Time-and-Motion Cost Analysis

A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework

Medication review in hospitalised patients to reduce morbidity and mortality

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