Implementation of a team-based pharmacy practice model resulted in a significant decrease in the rate of 30-day readmissions for high-risk patients.

Study Objective To determine if recommendations made by pharmacists and accepted by hospital physicians resulted in fewer post-discharge readmissions and urgent care visits compared to recommendations that were not implemented. Design Prospective review of pharmacist recommendations. Setting Patients admitted to a tertiary hospital and discharged to private community-based care. Patients A total of 192 subjects age 18 years or older who were a subsample of a randomized, prospective study, admitted with one of 10 cardiovascular or pulmonary disease or diabetes and utilized private community physicians and community pharmacies. Measurements and Main Results Pharmacy Case Managers (PCMs) performed evaluations for subjects and made recommendations to inpatient physicians. Subjects received medication counseling, a medication list and wallet card at discharge. Data from subjects and private physicians for 90 days post-discharge were collected. PCMs made 546 recommendations to inpatient physicians for 187 (97%) subjects. Overall, 48% of the recommendations were accepted. The acceptance rate was lower for those who ended up with an urgent care visit compared to other subjects (33.6% vs. 52.2%, p=0.033). There were high acceptance rates for medication reconciliation (78%, n=36) and when there was an actual allergy (100%, n=2) or medication error (100%, n=2). Physicians were less likely to accept recommendations related to medication indication (p<0.001), efficacy (p=0.041), and therapeutic disease monitoring (p=0.011). Recommendations made for subjects with a greater number of medications were also less likely to be accepted (p=0.003). Conclusion Recommendations to reconcile medications or address actual allergies or medication errors were frequently accepted. However, only 48% of all recommendations were accepted by inpatient physicians and there was no impact on healthcare utilization 90 days after discharge. This study suggests that recommendations by PCMs were underutilized and the low acceptance rate may have reduced the potential to avoid readmissions.

Influenza and pneumococcal disease contribute substantially to the burden of preventable disease in the United States. Despite quality measures tied to immunization rates, health systems have struggled to achieve these targets in the inpatient setting. Pharmacy departments have had success through implementation of pharmacist standing order programs (SOP); however, these initiatives are labor-intensive and have not resulted in 100% immunization rates. The objective of this study was to evaluate a pilot utilizing pharmacy technician interventions, in combination with a nursing SOP, to improve vaccination rates of hospitalized patients for influenza and pneumococcal disease. A process was developed for pharmacy technicians to identify patients who were not previously screened or immunized during the weekend days on the Cardiovascular Progressive Care unit at the University of Kansas Health-System. Targeted pharmacy technician interventions consisted of phone call reminders and face-to-face discussions with nursing staff. The primary study outcome was the change in immunization compliance rates between the control and intervention groups. Influenza vaccine rates showed a statistically significant increase from 72.2% (52 of 72) of patients during the control group to 92.9% (65 of 70, = .001) of patients during the intervention group. A pneumococcal vaccination rate of 81.3% (61 of 75) was observed in the control group, compared with 84.3% (59 of 70) of patients in the intervention group ( = .638). An improvement in inpatient influenza immunization rates can be achieved through targeted follow-up performed by pharmacy technicians, in combination with a nursing-driven SOP.

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