TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate

It has been found that nearly 20% of Medicare patients are readmitted to the hospital within 30 days of discharge. This high incidence of readmission can lead to increased costs for Medicare and its beneficiaries.  Because of this, the Centers for Medicare and Medicaid Services have begun penalizing hospitals with readmission rates higher than the national average for a particular disease state by decreasing reimbursement back to the hospital. The leading cause for readmission of these patients was attributed to a medication-related problem. A study conducted in Ohio looked to determine the impact that pharmacist intervention can have when implemented during transition of care.

Kroger pharmacies partnered with two small community hospitals in the Cincinnati area for patient referral as part of the TransitionRx program. At the time of hospital discharge, nurses counseled the patients on their medications with no input from pharmacists. Patients included in the study were aged 18 or older and diagnosed with either CHF, COPD, or pneumonia. Seven clinical pharmacists received training to provide MTM services with a special focus on counseling post-discharge patients. At the time of discharge, the hospitals faxed patient information, including discharge instruction and medications to the pharmacists at the designated Kroger locations. Pharmacists then made phone calls to these patients to schedule an in-person MTM session ideally within 3 days of discharge. During these appointments, the pharmacists provided a discussion of any changes in medication, a comprehensive medication review, and disease-state education, with a special focus on “red flags”. “Red flags” were defined as specific symptoms that patients could monitor for that could indicate their disease is deteriorating. Patients were provided with a personal medication record, health action plan, an appointment list, a self-monitoring log, if applicable, and a summary of the visit was sent to the patient’s physician. A follow-up was conducted via telephone.

90 patients participated in the study and 30 received the pharmacist intervention. Of the 60 patients that did not receive discharge counseling from a pharmacist, 20% were readmitted to the hospital within 30 days, while only 7% of patients in the intervention group were readmitted. Over 200 unique interventions were made by the pharmacists to the 30 patients that they saw, with 7 interventions per patient on average.

I enjoyed reading this article because the MTM sessions carried out by the pharmacists are extremely similar to what we have been learning to do in POP with standardized patients and with SilverScripts. It is encouraging to know that even as P1’s we are already preparing for our future careers and learning skills that will be essential to patient care in the future. Understanding Medicare STAR ratings and hospital reimbursements as the future of healthcare and realizing that patient health is the priority will help to develop a patient-centered approach as pharmacists. This article also highlights the need for pharmacists working with the interprofessional healthcare team and the benefits that can be provided. With just 7 participating pharmacists being able to identify over 200 drug therapy problems in 30 patients, the need for intervention is clear to see.

Reference:

J Am Pharm Assoc. 2015;55:246-254.

http://www.japha.org/article/S1544-3191(15)30055-8/pdf

Early Hospital Readmission After Simultaneous Pancreas-Kidney Transplantation

Transplant patients have a fairly high risk for early hospital readmission (EHR) after discharge, which has been linked to higher morbidity, mortality, and cost for hospitals and patients. Studies have been done to determine the risk of EHR for patients who receive kidney transplants, but this study is one of the first to look at factors contributing to EHRs following simultaneous pancreas-kidney transplantation (SPK). SPK is a form of treatment for diabetes and end stage renal disease.

The objective of this study was to determine the patient and center-level factors that contribute to the likelihood of EHR after SPK. The study was conducted nationally from 1999-2011 and included 3643 adult first-time SPK recipients whose primary insurance was Medicare Part A and B. Patient-level factors investigated included recipient and donor age, sex, race, and BMI as well as recipient comorbidities, length of stay for SPK, and year of transplant, and donor cause of death. Center-level factors investigated included total number of SPKs, average length of stay, percent of African American SPK patients, and median time to transplant. EHR was considered to be at least one hospital readmission within 30 days of discharge following SPK length of stay.

The study results showed that 55.5% of SPK recipients had at least one EHR and 23.1% of those were due to infections. Other major reasons for readmission included kidney/urinary tract disorders, alimentary tract disorders, pancreatic/hepatobiliary disorders, and electrolyte/nutritional disorders. Patient-level factors that were associated with an increased risk of EHR were younger recipients, African American donors, overweight donors, and length of stay. No center-level factors were found to affect the likelihood of EHR.

I found it particularly interesting that the study pointed out that younger patients may be more likely to have an EHR following SPK because young adults with type 1 diabetes may not be as compliant with their postoperative medication regimens as older adults. I think that this could be a great way to bring a pharmacist into this conversation about post-transplant EHRs. A pharmacist might be especially useful in helping patients to reach glycemic control and in managing immunosuppressive medications following SPK. In what other ways do you think a pharmacist may be able to contribute to lowering the risk of EHRs in SPK (or any type of transplant) recipients?

 

 

Am J Transplant. 2016; 16 (2): 541-549.