The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce...

Area of Science:

• Geriatric Medicine
• Health Services Research
• Clinical Pharmacy

Background:

• Older adults experience significant challenges with post-hospitalization medication management.
• These challenges contribute to adverse drug events, morbidity, mortality, and hospital readmissions.
• Pharmacist-led interventions show promise in reducing adverse drug events, but evidence on readmission reduction is limited.

Purpose of the Study:

• To evaluate the effectiveness of the PHARMacist Discharge Care (PHARM-DC) intervention in reducing 30-day hospital readmissions.
• To assess the implementation barriers and facilitators of the PHARM-DC intervention.
• To determine the cost-effectiveness of the PHARM-DC intervention.

Main Methods:

• A pragmatic, patient-level randomized clinical trial involving 9776 patients across two large hospitals.
• The PHARM-DC intervention includes comprehensive medication reconciliation, review, patient education, and enhanced communication.
• Primary outcome is 30-day post-discharge utilization; secondary analyses include qualitative stakeholder interviews and cost-effectiveness study.

Main Results:

• The study is designed to detect a 2.5% absolute reduction in 30-day readmissions from a baseline of 27.5%.
• Qualitative data will explore implementation factors.
• Cost-effectiveness will be analyzed to highlight potential savings.

Conclusions:

• Demonstrating a business case for PHARM-DC could encourage wider hospital adoption of pharmacist-led medication management programs.
• Successful implementation may reduce readmissions and improve patient safety.
• This trial aims to provide evidence for the financial and clinical benefits of peri-discharge pharmacist interventions.