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

3 thoughts on “TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate”

  1. This article is really interesting in light of one that I recently read about hospital readmission rates for a specific type of transplant. I like that this article focuses on the role of the pharmacist in patient discharge and readmission to hospitals and really shows how big of an impact a pharmacist can have. I think that providing medication therapy management upon discharge from the hospital is extremely beneficial to both patients and hospitals, especially since reimbursement is now focused more on quality of care. Based on the positive results of this article, I hope to see more pharmacist involvement in the discharge process in the future.

  2. It is exciting to see the great impact pharmacists can make to improve the health outcomes of patients. I believe the expansion of MTM services can reduce drug-therapy problems for all groups of patients, especially those discharged from hospital. I like how the article provided statistical support for the benefit of MTM services. It is also a bit surprising to me that pharmacists made 7 interventions per patient on average, which revealed the importance of pharmacists within the healthcare team.

  3. The title of this article caught my eye immediately, and it was encouraging to read about the difference that pharmacist-provided MTM services can really make in patient outcomes. I feel that MTM services specifically for post-discharge medications are very important, because I have seen many patients or caregivers very confused over their medications after discharge when they come to the pharmacy, regardless of instructions and extensive paperwork they receive at the hospital. There are so many other issues for them to consider, such as home care, transport, rehab, and diet, that many patients may not consider what is going on with their new medications until after they get home and start to take them. This is the point where a follow-up MTM, as discussed in the article, can really make a difference. I hope that studies such as this one will promote more coverage and opportunities for MTM services for patients after hospital discharge.

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