Journal of Primaryhttp://jpc.sagepub.com/ Care & Community Health
Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions Emily M. Hawes, Whitney D. Maxwell, Sarah F. White, Jesica Mangun and Feng-Chang Lin Journal of Primary Care & Community Health 2014 5: 14 originally published online 17 September 2013 DOI: 10.1177/2150131913502489 The online version of this article can be found at: http://jpc.sagepub.com/content/5/1/14
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502489
research-article2013
JPCXXX10.1177/2150131913502489Journal of Primary Care & Community HealthHawes et al
Pilot Study
Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions
Journal of Primary Care & Community Health 2014, Vol 5(1) 14–18 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150131913502489 jpc.sagepub.com
Emily M. Hawes1,2, Whitney D. Maxwell3, Sarah F. White4, Jesica Mangun1,2, and Feng-Chang Lin1
Abstract Purpose: Medication errors related to hospital discharge result in rehospitalization and emergency department (ED) visits, yet no systematic approach has been implemented nationally to decrease these medication errors. Pharmacist involvement during postdischarge transitions of care may be an important strategy to prevent and correct medication discrepancies and reduce costly rehospitalization and ED visits. Methods: This prospective, randomized, open-label, pilot study evaluated the effect of a pharmacy clinic visit focused on medication reconciliation and patient education after hospital discharge on the incidence of rehospitalization and ED visits and the resolution of medication discrepancies. Results: Of the 61 subjects included in the study, 33 (54%) had medication discrepancies identified at discharge. Fifty percent of medication discrepancies were resolved in subjects randomized to the pharmacist intervention arm compared with 9.5% in the usual care arm (P = .015). Patients randomized to the intervention arm had significantly lower rates of the primary composite outcome of 30-day rehospitalization and ED visits compared with the usual care arm (0% vs 40.5%, P < .001). Conclusion: A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care resource utilization in this pilot study. Keywords transitions, medication reconciliation, patient education, continuity, pharmacist
Introduction Between 20% and 70% of patients have at least one medication discrepancy at discharge, and patients with discrepancies are twice as likely to be rehospitalized within 30 days.1-5 Discharge-related medication discrepancies increase health care resource utilization, including rehospitalization and emergency department (ED) visits.2,3,6 Medication discrepancies cause discharge-related adverse drug events, which occur in 12% to 17% of patients, and the incidence increases when 8 or more medications are prescribed.1,3,4,7-9 The risk of having an adverse drug event is greatest during the first 7 to 10 days after discharge, which is a particular concern for primary care providers (PCPs) who may not be able to offer patients appointments within this time frame.10 A pharmacy intervention immediately after discharge may address this concern. With national health care quality organizations and the Affordable Care Act increasing accountability for rehospitalization, health systems will face financial penalties if they fail to meet 30-day rehospitalization performance
measures.11-13 A recently published systematic review of transitional care interventions included 47 studies evaluating various strategies to improve discharge-related patient safety, but no conclusions could be drawn regarding an optimal strategy. The review identified clinical pharmacist interventions as a promising approach based on literature evaluating primarily telephone-based strategies.14 Five studies have evaluated the impact of pharmacist telephone follow-up to reinforce the discharge plan, resolve medicationrelated problems, and provide medication counseling within 2 to 7 days of hospital discharge from general medicine 1
University of North Carolina, Chapel Hill, NC, USA University of North Carolina Hospitals, Chapel Hill, NC, USA 3 South Carolina College of Pharmacy, Columbia, SC, USA 4 Sullivan University College of Pharmacy, Louisville, KY, USA 2
Corresponding Author: Emily M. Hawes, Department of Family Medicine, University of North Carolina School of Medicine, 590 Manning Drive, Campus Box 7595, Chapel Hill, NC 27599, USA. Email: [email protected]
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15
Hawes et al Table 1. Inclusion Criteria and Exclusion Criteria. Inclusion Criteria (Year 1)
Inclusion Criteria (Year 2)
Patient must meet 1 of the 3 criteria below: Reason for admission: •• Heart Failure •• COPD •• Hyperglycemic crisis •• Stroke •• NSTEMI/UA More than 3 hospitalizations in the past 5 years 8 or more scheduled medications anticipated at discharge
8 or more scheduled medications anticipated at discharge
Exclusion Criteria Age
Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions Emily M. Hawes, Whitney D. Maxwell, Sarah F. White, Jesica Mangun and Feng-Chang Lin Journal of Primary Care & Community Health 2014 5: 14 originally published online 17 September 2013 DOI: 10.1177/2150131913502489 The online version of this article can be found at: http://jpc.sagepub.com/content/5/1/14
Published by: http://www.sagepublications.com
Additional services and information for Journal of Primary Care & Community Health can be found at: Email Alerts: http://jpc.sagepub.com/cgi/alerts Subscriptions: http://jpc.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Jan 2, 2014 OnlineFirst Version of Record - Sep 17, 2013 What is This?
Downloaded from jpc.sagepub.com at TEXAS SOUTHERN UNIVERSITY on November 12, 2014
502489
research-article2013
JPCXXX10.1177/2150131913502489Journal of Primary Care & Community HealthHawes et al
Pilot Study
Impact of an Outpatient Pharmacist Intervention on Medication Discrepancies and Health Care Resource Utilization in Posthospitalization Care Transitions
Journal of Primary Care & Community Health 2014, Vol 5(1) 14–18 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150131913502489 jpc.sagepub.com
Emily M. Hawes1,2, Whitney D. Maxwell3, Sarah F. White4, Jesica Mangun1,2, and Feng-Chang Lin1
Abstract Purpose: Medication errors related to hospital discharge result in rehospitalization and emergency department (ED) visits, yet no systematic approach has been implemented nationally to decrease these medication errors. Pharmacist involvement during postdischarge transitions of care may be an important strategy to prevent and correct medication discrepancies and reduce costly rehospitalization and ED visits. Methods: This prospective, randomized, open-label, pilot study evaluated the effect of a pharmacy clinic visit focused on medication reconciliation and patient education after hospital discharge on the incidence of rehospitalization and ED visits and the resolution of medication discrepancies. Results: Of the 61 subjects included in the study, 33 (54%) had medication discrepancies identified at discharge. Fifty percent of medication discrepancies were resolved in subjects randomized to the pharmacist intervention arm compared with 9.5% in the usual care arm (P = .015). Patients randomized to the intervention arm had significantly lower rates of the primary composite outcome of 30-day rehospitalization and ED visits compared with the usual care arm (0% vs 40.5%, P < .001). Conclusion: A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care resource utilization in this pilot study. Keywords transitions, medication reconciliation, patient education, continuity, pharmacist
Introduction Between 20% and 70% of patients have at least one medication discrepancy at discharge, and patients with discrepancies are twice as likely to be rehospitalized within 30 days.1-5 Discharge-related medication discrepancies increase health care resource utilization, including rehospitalization and emergency department (ED) visits.2,3,6 Medication discrepancies cause discharge-related adverse drug events, which occur in 12% to 17% of patients, and the incidence increases when 8 or more medications are prescribed.1,3,4,7-9 The risk of having an adverse drug event is greatest during the first 7 to 10 days after discharge, which is a particular concern for primary care providers (PCPs) who may not be able to offer patients appointments within this time frame.10 A pharmacy intervention immediately after discharge may address this concern. With national health care quality organizations and the Affordable Care Act increasing accountability for rehospitalization, health systems will face financial penalties if they fail to meet 30-day rehospitalization performance
measures.11-13 A recently published systematic review of transitional care interventions included 47 studies evaluating various strategies to improve discharge-related patient safety, but no conclusions could be drawn regarding an optimal strategy. The review identified clinical pharmacist interventions as a promising approach based on literature evaluating primarily telephone-based strategies.14 Five studies have evaluated the impact of pharmacist telephone follow-up to reinforce the discharge plan, resolve medicationrelated problems, and provide medication counseling within 2 to 7 days of hospital discharge from general medicine 1
University of North Carolina, Chapel Hill, NC, USA University of North Carolina Hospitals, Chapel Hill, NC, USA 3 South Carolina College of Pharmacy, Columbia, SC, USA 4 Sullivan University College of Pharmacy, Louisville, KY, USA 2
Corresponding Author: Emily M. Hawes, Department of Family Medicine, University of North Carolina School of Medicine, 590 Manning Drive, Campus Box 7595, Chapel Hill, NC 27599, USA. Email: [email protected]
Downloaded from jpc.sagepub.com at TEXAS SOUTHERN UNIVERSITY on November 12, 2014
15
Hawes et al Table 1. Inclusion Criteria and Exclusion Criteria. Inclusion Criteria (Year 1)
Inclusion Criteria (Year 2)
Patient must meet 1 of the 3 criteria below: Reason for admission: •• Heart Failure •• COPD •• Hyperglycemic crisis •• Stroke •• NSTEMI/UA More than 3 hospitalizations in the past 5 years 8 or more scheduled medications anticipated at discharge
8 or more scheduled medications anticipated at discharge
Exclusion Criteria Age
