Laird Harrison

October 19, 2015

SAN FRANCISCO — Pharmacists might be able to reduce hospital readmissions by phoning discharged patients to check on their medications, a new study shows.

The calls might be most effective for patients who have been admitted at least twice in the same year, or in those who are taking a high number of medications, said Amy Drew, PharmD, from the St. Louis College of Pharmacy in Missouri.

"These are the groups for which we feel like we can make some difference," she told Medscape Medical News here at the American College of Clinical Pharmacy 2015 Global Conference.

Previous research has shown that 20% of patients discharged from the hospital experience an adverse event, and two-thirds of these are related to medication changes made during hospitalization, Dr Drew reported (Ann Intern Med. 2003;138:161-167).

Before 2013, Dr Drew and her colleagues at Mercy Hospital St. Louis would sometimes call patients to make sure they took their medication correctly.

Calling All Patients

In 2013, however, the pharmacists, along with students and residents, began contacting every patient discharged to two outpatient clinics to make sure the patients understood how to use the medication they had been prescribed. The team contacted more than 90% of patients in the 48 hours after discharge with phone calls; the rest were contacted with letters.

To determine if these calls prevented patients from ending up back in the hospital, the researchers compared outcomes before and after the implementation of the counseling program. Patients admitted for obstetrical or behavioral health treatment or elective surgery were excluded from the study, as were patients discharged to a nursing facility.

There were no significant differences in age, length of stay, number of medications at discharge, or percent of patients admitted in the previous year between the 248 patients who received the counseling and the 296 who did not.

However, significantly fewer patients in the counseling group than in the noncounseling group saw a healthcare provider in the 14 days after discharge (58.1% vs 80.7% ; P < .0001).

In 2013, Mercy Hospital also began encouraging patients to make appointments with their primary care providers after discharge, Dr Drew reported.

Readmission rates at 0, 20, 40, 60, and 80 days after discharge were lower in the counseling group than in the noncounseling group, although the difference fell short of significance (P = 0.0683).

For patients who visited their primary care provider in the 14 days after discharge, readmission to the hospital was a significant 40% less likely in the counseling group than in the noncounseling group (P = .0221). This remained true after adjustment for age, length of stay, number of medications at discharge, and hospital admissions in the previous year.

Patients in the counseling group with a diagnosis of pneumonia, heart failure, or acute myocardial infarction were also less likely to be readmitted to the hospital than those in the noncounseling group, but the difference was not significant (P = .0853).

Patients taking 13 or more medications at discharge were a significant 50% more likely to be readmitted to the hospital than those taking seven or fewer medications (P = 0.0002).

And patients admitted to the hospital twice in one year were 2.4 times more likely to be readmitted than those not admitted that often, after adjustment for visits to primary care providers within 14 days, age, length of stay, intervention, and number of medications at discharge.

The researchers are planning further analyses to see if calls from pharmacists benefit patients taking a large number of medications and those admitted to the hospital more than once in a year, Dr Drew reported.

They also plan to continue collecting patient records in the hope of improving the statistical power of the study, she said.

Until then, this study is not likely to affect clinical practice, explained Gayle Scott, PharmD, from the Eastern Virginia Medical School in Norfolk.

"Larger studies for longer periods of time are needed," she told Medscape Medical News.

No funding was provided for this study. Dr Drew and Dr Scott have disclosed no relevant financial relationships.

American College of Clinical Pharmacy (ACCP) 2015 Global Conference: Abstract 11. Presented October 18, 2015.


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