Improving care transitions through medication therapy management: A community partnership to reduce readmissions in multiple health-systems

Abstract

Objectives: The primary objective was to measure the impact of a pharmacist-provided medication therapy management program on 30-day postdischarge readmission rates. The secondary study objectives were to characterize the number and types of pharmacist interventions, to determine the impact of the intervention on primary and secondary medication nonadherence, and to measure patient satisfaction with the intervention.

Design: Randomized, clinical trial.

Setting: Six hospitals and a supermarket pharmacy chain with 60 pharmacies.

Participants: Four hundred patients discharged from a participating hospital with acute myocardial infarction, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, or diabetes.

Main outcome measures: Primary outcome measure was 30-day readmission rate. Secondary outcomes were pharmacist interventions, primary and secondary medication nonadherence, and patient satisfaction.

Results: Four hundred patients were enrolled. There was not a significant difference in 30-day readmission rates between intervention and control groups (11.3% vs. 10.7%; P = 0.49). A large portion of patients randomized to the intervention did not attend their appointment. In a per protocol (PP) analysis, which included the 62 intervention patients who attended their appointment and the 187 patients in the control group, there was a significant difference in 30-day readmission rates (1.6% vs. 10.7%; P = 0.02). In the PP analysis, controlling for baseline differences, patients in the intervention group were significantly less likely to experience a readmission (odds ratio, 0.126; 95% confidence interval, 0.016-0.968; P = 0.046). In the PP analysis, the percentage of prescriptions not picked up in the intervention group compared with the control group was reduced by 2.5%, (6.4% vs. 8.9%; P = 0.59). Pharmacists identified many interventions, averaging 6 per patient.

Conclusion: This study successfully implemented a large-scale transition of care program between multiple health systems and community pharmacies that reduced hospital readmissions. Pharmacists identified many interventions for patients. The transmission of patient information from the inpatient setting to the community pharmacy is key to transitioning patients successfully.