A community pharmacist-led service to facilitate care transitions and reduce hospital readmissions

作者：Feldman Joshua D; Otting Rachel I; Otting Craig M; Witry Matthew J^*

来源：Journal of the American Pharmacists Association, 2018, 58(1): 36-43.

DOI：10.1016/j.japh.2017.09.004

Objectives: To assess the impact of a community pharmacist-delivered care transition intervention on 30-day hospital readmissions.
Setting: A single private 263-bed hospital in the Midwest United States and 12 partnering community pharmacies, 1 serving as primary pharmacy.
Practice innovation: Adult general medicine inpatients were evaluated by nursing staff with the use of a worksheet based on the Better Outcomes by Optimizing Safe Transitions (BOOST) readmission risk toolkit. The highest-risk patients were enrolled in a 3-contact intervention. First, a pharmacist from the primary community pharmacy delivered an in-room work-up. The pharmacist focused on medication education, problem identification, and verifying medication access following discharge. A pharmacist visited the hospital for approximately 4 hours most weekdays, during which the pharmacist saw 3-4 patients. A community pharmacist telephoned these patients 8 and 25 days after discharge.
Evaluation: The intervention was provided to 555 patients who had a mean readmission risk worksheet score of 1.90 (SD 1.13) and not provided to 430 patients with lower readmission risk worksheet scores, which averaged 0.68 (SD 0.86; P < 0.001). Thirty-day readmissions to the study hospital were lower for intervention patients (8.1%) versus comparison patients (21.4%; P < 0.001). Thirty-day readmissions to any hospital were calculated for a subsample of 129 intervention patients and 103 comparison patients with Medicare Fee for Service insurance for which claims were available, but the difference (10.9% and 15.5%, respectively) did not reach statistical significance (P = 0.328).
Practice implication: A community pharmacy was successful in partnering with a hospital and other community pharmacies to lead a care transitions intervention associated with reduced 30-day same-hospital readmissions.
Conclusion: A community pharmacist-led intervention delivered to higher-risk patients showed a significant decrease in readmission rate to the same hospital compared with lower-risk patients hospitalized in the same unit but not receiving the intervention. This supports the community pharmacists' role in care transitions.

• 出版日期2018-2