Clinical Pharmacist Transition of Care Model Improves Hospital System Practice by Reducing Readmissions

Area of Science:

• Clinical Pharmacy
• Patient Safety
• Health Outcomes Research

Background:

• Medication-related problems (MRPs) are a primary driver of hospital readmissions.
• Polypharmacy, the concurrent use of multiple medications, increases the risk of MRPs and 30-day hospital readmissions.

Purpose of the Study:

• To assess the effectiveness of a pharmacist-led transition of care program in reducing hospital readmissions among polypharmacy patients.
• To evaluate the impact of pharmacist interventions on identifying and resolving MRPs.

Main Methods:

• A prospective study involving 536 polypharmacy patients (≥10 home medications) receiving pharmacist interventions.
• Interventions included admission interviews, medication reconciliation, consultations, and postdischarge follow-up.
• A control group (n=2317) received standard care.

Main Results:

• The intervention group had a significantly lower 30-day readmission rate (8.8%) compared to the control group (12.4%).
• Pharmacist intervention reduced the likelihood of 30-day readmission by 33% (OR=0.67).
• All study participants had at least one medication-related discrepancy.

Conclusions:

• Pharmacist-led transition of care programs are effective in reducing hospital readmission rates.
• Resolving medication-related problems through comprehensive medication management is key to improving patient outcomes and reducing readmissions.