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Clinical Question
Can a pharmacist-led intervention reduce hospital readmissions and emergency department visits?
Bottom line
An extensive intervention by hospital pharmacists—including multiple medication reviews, motivational interviews with patients, communication with primary care physicians, and follow-up phone calls after discharge—led to a reduction in short-term and long-term readmission rates. The cost effectiveness of such an intervention has not yet been determined. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
In this study from Denmark, investigators randomized 1467 hospitalized patients who were taking 5 or more prescription medications to receive usual care, a basic pharmaceutical intervention, or an extended pharmaceutical intervention. The basic intervention group received a medication review by a clinical pharmacist shortly following admission to the hospital with recommendations made by the pharmacist to the hospital physician regarding potential medication changes. The extended intervention group received the same medication review upon admission, but also received the following: (1) medication reconciliation discussion between the pharmacist and the patient prior to discharge using a motivational interview approach; (2) a summary note encompassing changes in medications sent to the primary care physician; (3) phone calls by the pharmacist to the primary care physician, caregiver, and primary pharmacist after discharge if medications were changed during hospitalization; and (4) follow-up phone calls by the pharmacist to the patient 1 week and 6 months after discharge to discuss medications, again using the motivational interview approach. All pharmacists involved in the intervention received training in medication review and motivational interview techniques. The average time spent on the basic and extended interventions was 26 minutes and 114 minutes, respectively. The primary outcome of the composite of 30-day and 180-day readmission rates and emergency department visits within 180 days was decreased in the extended intervention group as compared with the usual care group (hazard ratio 0.77; 95% CI 0.64 - 0.93). When looking at individual outcomes, readmission rates were reduced both at 30 days and 180 days but there was no significant difference detected in the rate of emergency department visits between the extended intervention and usual care groups. In addition, drug-related readmissions or deaths were not different between the 2 groups. No significant differences were noted in any outcomes comparing the basic intervention to usual care, suggesting that a medication review alone is not sufficient to reduce the number of emergency department visits and readmissions.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
This is written in a very confusing way. So do pharmacist interventions reduce readmissions or not? It says one thing in ‘headline’ and another in last sentence. This needs to be rewritten. I am surprised it got through the editor.
This is a recurring problem for patients discharged from the hospital. Pharmacists should continue to be involved.
also more integration with patient's own pharmacy / -ist !
ED visits and readmits
I find the synopsis a bit confusing regarding ED visits after drug intervention. First it reports the outcome that visit rates were reduced. Then it reports that visit rates were not reduced.
With drug intervention, it reports that drug related readmits and deaths were not reduced.
Appreciated this poem. Multidisciplinary team collaboration is the future of medicine and improved pt care/outcomes.
Interesting study. Not surprising multi-disciplinary care impacts patient care. Although not studied I am sure this is cost effective.
good poem
Not surprising- the pharmacist is the best person to advise on the possible interaction of all the medications beside any contraindication which can be patient specific . Hence their follow up involvement will be very beneficial.