Effect of extended pharmacist involvement in discharge transitions of care on hospital readmission rates: Prospective, randomized, parallel arm design trial

Abstract

Pharmacist involvement in transitions of care has been shown to improve patient outcomes and reduce readmission rates. Pharmacists reduce medication errors at discharge by ensuring all home medications continued are appropriate, provide pharmacist discharge patient medication education on new and existing medications therapies, and evaluate the safety and efficacy of the patient's medication therapy in order to decrease readmission rates. Results from this study may provide a financial benefit for hospital reimbursement by reducing 30 day readmission rates. The primary outcome was the comparison of composite emergency department (ED) and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus standard of care. Patients 18 years of age and older with a readmission risk score of 25 or greater, and admitted on general medicine floors from November 1, 2022 through February 28, 2023 were included. Patients were randomized into a standard of care (SOC) or extended SOC group. The primary outcome was the comparison of composite ED and hospital 30 day readmission rates for patients that have extended pharmacist intervention at discharge versus SOC. A key secondary outcome included number of drug‐related problems identified and resolved. The primary outcome was analyzed using chi‐squared analysis (alpha of 0.05) and secondary outcomes as descriptive statistics. Data was analyzed using Stata® 16.1 statistical software. Two hundred and ninety‐six patients were included for analysis with 148 patients in both extended SOC and SOC groups. Extended SOC decreased the composite 30 day ED visit and hospital readmission rate by 7% (p = 0.63). Extended SOC group decreased 30 day ED visits by 4.9% and inpatient 30 day readmissions by 8.2% analyzed using descriptive statistics. Patients in extended SOC group resulted in a non‐statistical decrease in ED visits and inpatient readmissions 30 days after discharge compared to SOC group.

Pharmacists and transitions of care

“…Tasseff et al 2 used an internally-validated readmission risk tool to identify patients included in their TOC programs. Our systematic review 3 also showed significant heterogeneity in the methods used to identify and provide services for these patients.…”