Pharmacists Help Reduce Hospital Readmission in Low Health Literacy Patients

Patients often leave the hospital on different and more complicated drug therapies.

Patients with limited health literacy are especially vulnerable to medication-related problems that contribute to hospital readmissions.

Thirty-day readmission rates in acute decompensated heart failure and acute myocardial infarction patients are 24.6% and 19.9%, respectively. During or after admission for these 2 conditions, clinicians often change patients' regimens, and patients often leave the hospital on different and more complicated drug therapies.

The Journal of General Internal Medicine recently published a study that shows targeted pharmacist interventions may reduce unplanned health care utilization among patients with limited health literacy.

This Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study employed medication reconciliation, inpatient counseling, low-literacy adherence aids, and individualized telephone follow-up to reduce 30-day hospital readmissions. It enrolled patients with acute coronary syndrome (ACS) and acute decompensated heart failure at 2 academic centers.

The researchers measured patient health literacy with the Test of Functional Health Literacy in Adults and preadmission medication adherence with the 4-item Morisky instrument.

Although pharmacist intervention produced no statistically significant impact on health care utilization in both patient groups, it reduced health care utilization significantly, primarily through decreased emergency department visits, among patients with limited health literacy.

Patients with limited health literacy have more to gain from pharmacist intervention. They face barriers to care that pharmacists can help bridge.

Overall, the study population had higher than expected health literacy, and the study’s settings already employed successful transitional care programs. In addition, the study’s medication-related problem focus limited the effect of the interventions compared with other more multifactorial studies.

The overall findings support targeting patients with low health literacy to produce the greatest benefit with limited resources. The researchers recommended stratifying patients based on health literacy at admission and including pharmacist-driven medication-related problem interventions in a multidisciplinary and multifactorial initiative.