Pharmacist-Led Discharge Care to Reduce Postdischarge Health Care Utilization: A Randomized Clinical Trial

Area of Science:

• Gerontology
• Health Services Research
• Pharmacology

Background:

• Pharmacist-led transitions of care (TOC) interventions are known to reduce adverse drug events post-hospitalization.
• However, healthcare organizations often lack financial incentives to fund these crucial interventions.

Purpose of the Study:

• To evaluate the impact of pharmacist-led TOC interventions on healthcare resource utilization after hospital discharge.
• To determine if these interventions can reduce hospital readmissions and emergency department visits.

Main Methods:

• A pragmatic randomized clinical trial was conducted in two US urban teaching hospitals.
• Participants included hospitalized adults aged 55+ with polypharmacy (≥10 long-term or ≥3 high-risk medications).
• The intervention involved pharmacist-led medication management during and after discharge, compared to usual care.

Main Results:

• No significant reduction in 30-day unplanned all-hospital or same-hospital utilization was observed in the overall study population.
• A significant reduction in same-hospital unplanned utilization was found in a subgroup of patients with low medication adherence and literacy (10.4 pp decrease).
• This subgroup benefit suggests targeted application of TOC interventions may be effective.

Conclusions:

• Pharmacist-led TOC interventions did not demonstrate an overall reduction in 30-day hospital or ED utilization among older adults with polypharmacy.
• The intervention showed significant benefit for the subgroup of patients with low medication adherence and literacy.
• Findings suggest that TOC interventions may be particularly beneficial for specific patient populations with identified medication management challenges.