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Published on: July 14, 2023
Evaluation of Clinical Pharmacist Services in a Transitions of Care Program Provided to Patients at Highest Risk for
Jessica E Fennelly1, Antoinette B Coe2, Kellie A Kippes1,2
1Pharmacy Innovations and Partnerships, Michigan Medicine, Ann Arbor, MI, USA.
Background:
An ambulatory transition of care program, including a pharmacist-provided comprehensive medication review (CMR), was implemented.
Objectives:
The objectives were to: (1) compare 30-day hospital readmission rates between those who received the pharmacist CMR versus eligible patients not scheduled, (2) describe identified problems and recommendations, and (3) quantify recommendation acceptance rates.
Methods:
A retrospective cohort study was conducted between March and October 2016. Inclusion criteria were: LACE score of ≥13, established Michigan Medicine primary care, and discharged from specific inpatient services to home. The primary outcome was 30-day hospital readmission rates. Pharmacist-identified problems, recommendations, and recommendation acceptance rates were examined. χ2 analysis and descriptive statistics were used.
Results:
355 discharges met inclusion criteria and pharmacists provided CMRs for 159 patients. The average age was 60 years (standard deviation [SD]: 14.3), the majority were female (54%), and white/Caucasian (69%). There was no significant difference in 30-day readmission rates in patients who received a CMR (p = .96). A mean of 3.1 problems were identified per visit (SD: 1.8, range: 1-10). 509 recommendations were provided and approximately 50% were provider accepted.
Conclusions:
Reduced readmission rates were not observed; however, pharmacists identified many areas for intervention in highest risk patients during the transition from hospital to home.
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