Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial

Abstract

BACKGROUND: Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. OBJECTIVE: The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. DESIGN: Randomized, controlled trial with concealed allocation and blinded outcome assessors SETTING: Two tertiary care academic medical centers PARTICIPANTS: Adults hospitalized with a diagnosis of ACS and/or ADHF INTERVENTION: Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge MAIN MEASURES: The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Prespecified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) are reported. KEY RESULTS: A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95 % CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95 % CI 0.51-1.15; BWH aHR = 1.44 (95 % CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95 % CI 0.17-1.00). There was no difference in treatment effect by patient cognition. CONCLUSION: A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce postdischarge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.

What Patient Characteristics Influence Nurses’ Assessment of Health Literacy?

“…Moreover, some patient education interventions are resource-intensive and should be delivered only to higher-risk patients, or they have been shown to provide the most benefit to patients with low health literacy. For example, we recently demonstrated that an educational intervention that aimed to improve outcomes after hospital discharge was effective for patients with inadequate health literacy, but not for patients with adequate health literacy (Bell et al, 2016). Thus, using a screening tool, such as the BHLS, to identify these patients could enable health systems to better target resources.…”

The impact of the pharmacist on continuity of care during transitions of care: A systematic review

“…31,36,42 Of the 3 studies that did not reach statistical significance, 2 conducted 2 phone calls, at 3 and 14e30 days after discharge, and used only a pharmacist to conduct the interventions, 25 and 1 conducted the phone calls 4 days after discharge and then as needed, with the use of a multidisciplinary team. 38 The other study reaching statistically significant reductions in readmission rates conducted only 1 phone call within 3 days after discharge and used only a pharmacist. 44…”

Impact of Pharmacist‐led Discharge Counseling on Hospital Readmission and Emergency Department Visits: A Systematic Review and Meta‐analysis

“…Only three studies were considered as low risk of bias for all domains. 22,37,40 Analyses on publication bias were performed by visualization of funnel plots and showed overall symmetry in all cases, which demonstrates a relative lack of bias. Few studies contributed to a slight asymmetry in the plots.…”