Evaluation of Pharmacist Medication Education and Post-discharge Follow-up in Reducing Readmissions in Patients With ST-Segment Elevation Myocardial Infarction (STEMI)

Budiman, T.A.; Snodgrass, Kimberly; Chang, Allison

doi:10.1177/1060028015620425

Cited by 37 publications

(62 citation statements)

References 15 publications

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“…Despite the previously reported poor awareness about the risk of NSAID use among the heart failure patients, the findings of this study indicate that a hospital‐based education programme incorporating patient counselling and an educational leaflet can potentially improve their knowledge. This is consistent with previous studies, which underlined the importance of similar interventions in ameliorating the medication literacy of patients and reducing hospitalization …”

Section: Discussionsupporting

confidence: 93%

Effectiveness of a hospital-based education programme in improving knowledge of the use of nonsteroidal anti-inflammatory drugs among heart failure patients in a Malaysia regional hospital

Choong

Lew

George

et al. 2018

Journal of Pharmaceutical Health Services Research

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Objectives The use of nonsteroidal anti‐inflammatory drugs (NSAIDs) in heart failure patients is known to be associated with a wide range of adverse events, including an increased risk of cardiovascular complications. This study aimed to evaluate the effectiveness of an education programme in improving the knowledge about the safety of NSAID use among the hospitalized heart failure patients. Method This was a single‐arm, quasi‐experimental study. It was undertaken in a regional referral centre in Perak State, Malaysia. Each recruited patient received an educational leaflet and a 10‐min counselling intervention by a clinical pharmacist. A 5‐item questionnaire was used to assess their knowledge before and after the intervention. Each correct answer was awarded with 1 point, and a patient with a total score of 3 points or above was considered having adequate knowledge. Key findings A total of 31 patients received the intervention and completed the assessment. They were mainly female (61%), with a median age of 68 (interquartile range (IQR) = 22) years. Of all the patients, four (13.3%) reported a long‐term use of NSAIDs, while only one (3.2%) reported the use of NSAIDs in 1 week before the hospitalization. The postintervention score (median = 3; IQR = 2) was shown to be significantly higher than the preintervention score (median = 1; IQR = 2; P = < 0.001). Additionally, the majority of the patients (86.7%) found the education programme was useful to avoid unnecessary NSAID use in the future. Conclusions Our findings suggest that the pharmacist‐initiated education programme is useful and could be used as a long‐term strategy to improve the knowledge about the safety of NSAID use in heart failure patients.

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Section: Discussionsupporting

confidence: 93%

Effectiveness of a hospital-based education programme in improving knowledge of the use of nonsteroidal anti-inflammatory drugs among heart failure patients in a Malaysia regional hospital

Choong

Lew

George

et al. 2018

Journal of Pharmaceutical Health Services Research

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“…Despite the data supporting the involvement of pharmacists in TOC for patients with heart failure, the benefit has yet to be demonstrated in the ACS patient population . A study by Budiman et al in 2016 evaluated the impact of a pharmacist TOC program on readmission rates in patients admitted with ST‐segment elevation myocardial infarction (STEMI) . The TOC intervention included pharmacist‐led medication reconciliation, medication education, discharge instructions, and postdischarge phone calls within 48 to 72 hours and on day 30.…”

Section: Introductionmentioning

confidence: 99%

“…There is a significant heterogeneity in the TOC literature in regards to interventions performed and the effect of these interventions on patient outcomes. In a systematic review, no single intervention was associated with a reduction in 30‐day all‐cause readmissions but multiple “bundle” interventions, such as those performed by Budiman et al, may be effective at reducing readmissions …”

Section: Introductionmentioning

confidence: 99%

“…11,12 A study by Budiman et al in 2016 evaluated the impact of a pharmacist TOC program on readmission rates in patients admitted with ST-segment elevation myocardial infarction (STEMI). 13 The TOC intervention included pharmacist-led medication reconciliation, medication education, discharge instructions, and postdischarge phone calls within 48 to 72 hours and on day 30. The researchers found a nonsignificant reduction in 30-day all-cause readmission rates.…”

Section: Introductionmentioning

confidence: 99%

“…In a systematic review, no single intervention was associated with a reduction in 30-day all-cause readmissions but multiple "bundle" interventions, such as those performed by Budiman et al, may be effective at reducing readmissions. 13,14 A pharmacist-driven TOC service was implemented at our institution for patients admitted to the cardiac care team. At the request of executive level hospital leadership, this service was designed to target reductions in 90-day readmission rates in consideration of the bundled payments for care initiative by CMS.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a pharmacist‐driven transition of care program for patients with acute coronary syndromes

Gorman

Brown

Costello

et al. 2018

J Am Coll Clin Pharm

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Background Pharmacist‐driven transition of care (TOC) initiatives have been shown to reduce rates of medication errors and readmission rates in several patient populations, including heart failure. Existing literature evaluating pharmacist‐driven TOC initiatives targeting patients with acute coronary syndromes (ACSs) are limited. Objective To assess the impact of a newly implemented pharmacist‐driven TOC initiative on readmission rates in patients with ACS. Methods This was a retrospective, single‐center, pre‐post observational cohort study. Institutional review board approval was obtained. Patients were matched for age, gender, and ACS type with a historical cohort who received no pharmacist TOC intervention. The primary outcome was the 90‐day all‐cause readmission rate. Secondary outcomes included 30‐ and 90‐day cardiovascular‐related readmission rates as well as the 30‐day all‐cause readmission rate. Individual components of a pharmacist‐driven TOC initiative were also evaluated to determine what, if any, aspect of the program had the greatest association with reduced readmission. Results A total of 300 patients were included in the study; 150 patients in the pharmacist TOC group and 150 patients in the historical control group. There was a statistically significant reduction in all readmissions at 90 days in the pharmacist TOC group compared with the historical control group (24.7% vs 13.3%, P = .0124). Cardiovascular‐related readmissions were also significantly reduced in the pharmacist TOC group at 30 days (11.3% vs 4.7%, P = .0333) and at 90 days (16.7% vs 8.0%, P = .0225). A higher percentage of patients who were not readmitted received pharmacist medication history and reconciliation compared with patients who were readmitted (129 [99.2%] vs 18 [90%], respectively, P = .046). Conclusions The implementation of a pharmacist‐driven TOC initiative targeting ACS patients was associated with reduced readmission rates.

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In‐hospital mortality and readmission after ST‐elevation myocardial infarction in nonagenarians: A nationwide analysis from the United States

Ismayl

Balakrishna

Walters

et al. 2022

Cathet Cardio Intervent

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Objectives To assess readmission rates in nonagenarians (age ≥ 90 years) with ST‐elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) versus no pPCI. Background There are limited data exploring readmissions following STEMI in nonagenarians undergoing pPCI versus no pPCI. Methods We retrospectively analyzed the Nationwide Readmissions Database to identify nonagenarians hospitalized with STEMI. We divided the cohort into two groups based on pPCI status. We compared mortality during index hospitalization and during 30‐day readmission, readmission rates, and causes of readmissions. Results We identified 58,231 nonagenarian STEMI hospitalizations between 2010 and 2018, of which 18,809 (32.3%) included pPCI, and 39,422 (67.7%) had no pPCI. Unadjusted unplanned 30‐day readmission was higher in pPCI cohort (21.0% vs. 15.4%, p < 0.001). However, mortality during index hospitalization and during 30‐day readmission were significantly lower in pPCI cohort (15.8% vs. 32.2%, p < 0.001; 7.4% vs. 14.2%, p < 0.001, respectively). After adjusting for baseline characteristics, hospitalizations that included pPCI had 25% greater odds of unplanned 30‐day readmission (adjusted odds ratio [aOR]: 1.25, 95% confidence interval [CI]: 1.12–1.39, p < 0.001) and 49% lower odds of in‐hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46–0.56, p < 0.001). Heart failure was the most common cause of readmission in both cohorts followed by myocardial infarction. Conclusions In nonagenarians with STEMI, pPCI is associated with slightly higher 30‐day readmission but significantly lower mortality during index hospitalization and during 30‐day readmission than no pPCI. Given the overwhelming mortality benefit with pPCI, further research is necessary to optimize the utilization of pPCI while reducing readmissions following STEMI in nonagenarians.

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Evaluation of Pharmacist Medication Education and Post-discharge Follow-up in Reducing Readmissions in Patients With ST-Segment Elevation Myocardial Infarction (STEMI)

Abstract: Pharmacist involvement in medication education signficantly improved medication adherence and literacy. There was a reduction in 30-day readmission rates, but the results were not statistically significant.

Cited by 37 publications

References 15 publications

Effectiveness of a hospital-based education programme in improving knowledge of the use of nonsteroidal anti-inflammatory drugs among heart failure patients in a Malaysia regional hospital

Effectiveness of a hospital-based education programme in improving knowledge of the use of nonsteroidal anti-inflammatory drugs among heart failure patients in a Malaysia regional hospital

Impact of a pharmacist‐driven transition of care program for patients with acute coronary syndromes

In‐hospital mortality and readmission after ST‐elevation myocardial infarction in nonagenarians: A nationwide analysis from the United States

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