Community Pharmacists Can Reduce Hospital Readmission Rates

Community pharmacists can play a valuable role in preventing hospital readmissions through patient education and resolution of identified drug therapy problems, according to data reported in a poster presentation at the American Pharmacists Association (APhA) 2017 Annual Meeting & Exposition in San Francisco.

The study focused on a novel transitions of care service called Transition to Wellness, which was created through collaboration between Realo Discount Drugs and Onslow Memorial Hospital, and aimed to bridge the gap between community pharmacy and hospital practice. The authors set out to determine whether lack of follow-up care post-discharge, or misunderstanding of drug therapy instructions, contributed to likelihood of readmission.

In a statement to Pharmacy Times, authors Christy Holland PharmD, Christina Nunemacher PharmD, Macary Marciniak PharmD, and Sarah Jones PharmD, noted that, "In the past, community pharmacists did not know when their patients were admitted or discharged from the inpatient hospital setting. This service seeks to connect community pharmacists with their current patients, as well as patients needing their services, prior to hospital discharge."

To identify community pharmacists’ impact on likelihood of patient readmission, these authors assessed the effects of discharge education and follow-up by pharmacists on 30-day readmission rates, and evaluated the number of drug therapy problems (DTPs) identified.

The study was conducted from October 5, 2016 to February 26, 2017. Participants included patients aged 18 years or older who had been admitted with a primary diagnosis of chronic obstructive pulmonary disorder (COPD) (56%), heart failure (50%), or diabetes (33%), and had been discharged from the hospital. The enrollment of patients in this pilot study is separate from the actual numbers of patients enrolled in the Transition to Wellness service.

The Transition to Wellness Service included the following steps:

• Hospital staff screen patient upon admission.
• Pharmacist visits interested patient to explain service and enroll patient.
• Pharmacist identifies drug therapy problems.
• Pharmacist provides medication reconciliation.
• At discharge, pharmacist delivers medications and provides education.
• Pharmacist identifies drug therapy problems.
• Pharmacist reinforces education with patient on days 5, 14, and 25 post-discharge.

The authors provided a summary of the data, as explained below:

• 1107 patients were notified about the TTW service
• 149 patients expressed interest about the TTW service; these patients were further evaluated by the community pharmacist to determine if appropriate for the service 958 had no response recorded in the hospital record or expressed no interest in the service
• 48 interested patients were deemed eligible for the pilot study; all 48 were counseled regarding the pilot study for possible inclusion 101 interested patients were not eligible for the pilot study due to admitting diagnosis
• 18 eligible patients were enrolled in the pilot study 30 eligible patients were found to not meet criteria to be included in the study, or later elected to not be included in the study

According to the authors, types of drug therapy problems were monitored as the pharmacist provided transition of care services, in order to develop potential educational efforts among providers and make improvements to the TTW service. According to the data from this pilot study, the most common drug therapy problem was the absence of written prescriptions for the patient to continue post-discharge. It was beyond the scope of this practice to conduct a root cause analysis of the DTP's.

However, the community pharmacist was able to contact the physician to obtain needed prescriptions, which the authors stated was a novel intervention that allowed community pharmacists to ensure that patients were taking medications as intended from the prescriber post-discharge.

"Data from the study will be used to enhance the Transition of Wellness service, making it more effective at preventing hospital readmissions in the future," the authors concluded. "The service continues to seek to bridge the gap between community pharmacy practice and the care a patient receives."

Transition to Wellness received a grant from the Community Pharmacy Foundation to sustain the service while gathering data to support its effectiveness.

Reference

Jones S, Holland C, Nunemacher C, et al. Transition to Wellness: The impact of community pharmacist discharge education on readmission rates for patients with chronic obstructive pulmonary disease, heart failure, or diabetes. Presented at: American Pharmacists Association 2017 Annual Meeting & Exposition. March 24-27, 2017. San Francisco.