Implementation of transitions-of-care services through acute care and outpatient pharmacy collaboration

Gilmore, Vi; Efird, Leigh; Fu, Denise; LeBlanc, Yvonne; Nesbit, Todd; Swarthout, Meghan

doi:10.2146/ajhp140504

Cited by 31 publications

(29 citation statements)

References 6 publications

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“…Several of these studies were likely published with the intent of being proof of concept case studies or to demonstrate a new care model was feasible rather than to truly evaluate its effectiveness. [26,27] When we limited our sample to studies with larger samples, we found more definitive results. In particular, medication reconciliation and discharge planning were present in far more of the successful interventions than the unsuccessful ones, suggesting that these may be critical components to include in interventions designed to reduce medication readmissions.…”

Section: Issues In Assessing Intervention Successmentioning

confidence: 82%

“…[4,18] Of the 21 sample studies, only two [19,20] had a single intervention component, while 12 studies included four or more intervention components. [21][22][23][24][25][26][27][28][29][30][31][32] Several of the intervention components were employed in many of the studies we examined. Discharge planning (used in 7 studies) and provider education (used in 2 studies) were the least-often used intervention components.…”

Section: Characteristics Of Interventionsmentioning

confidence: 99%

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Interventions to address medication-related causes of hospital readmissions: A scoping review

Carroll

Joseph

Puro

2019

JHA

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Unplanned readmissions pose a tremendous burden on patients, providers, and payers. A significant proportion of readmissions are medication-related. Despite the availability of literature regarding hospital-level strategies to reduce readmissions, little has been written about strategies aimed at medication-related readmissions. We sought to identify successful readmission reduction strategies by performing a scoping literature review of research published between 2000 and 2017. We identified 21 studies that met our inclusion criteria. From these studies, we identified 7 components frequently employed as a part of interventions to reduce medication-related readmissions: discharge planning, discharge education, post-discharge telephone calls, the use of a professional coordinator with clinical training to administer the intervention, patient education efforts, provider training efforts, and medication reconciliation. Thirty-eight percent of all the interventions identified were associated with a statistically significant reduction in readmissions. Of the 7 common intervention components we identified, none were consistently associated with intervention success in the full sample. However, interventions implemented by inpatient hospitals, in particular academic medical centers, had a higher success rate than interventions implemented by other providers. We examined a subsample of larger studies and found that discharge planning and medication reconciliation components were included in most of the successful interventions. Future research should look beyond simply identifying components included in an intervention and should instead seek to identify contextual factors that enable or inhibit the success of these components. Research examining discharge planning and medication reconciliation efforts will be particularly important.

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Section: Issues In Assessing Intervention Successmentioning

confidence: 82%

Section: Characteristics Of Interventionsmentioning

confidence: 99%

Interventions to address medication-related causes of hospital readmissions: A scoping review

Carroll

Joseph

Puro

2019

JHA

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“…It is already known that care transitions lead to an increased risk of medication errors that can result in adverse events, prolonged hospital admissions, earlier readmissions, and overutilization of health care resources [11]. While pharmacist intervention during and after hospitalization has been frequently studied in the areas of medication reconciliation and discharge counseling, or on the use of a follow-up phone call, this is one of the few studies that have assessed medication adherence post-discharge in a program that includes all of these factors alongside bedside delivery of medications [12,13,14,15,16,17,18,19].…”

Section: Discussionmentioning

confidence: 99%

Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

2019

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This study assesses the effectiveness of a pharmacy-led transition of care (TOC) service on increasing patients’ understanding of, and reported adherence to, medication post hospital discharge. A cross-sectional survey was administered to patients who were discharged from the hospital with at least one medication received via bedside delivery from the TOC service. Adherence was assessed by asking the patient if they had taken their discharge medications as instructed by the prescriber. Satisfaction with the discharge medication counseling service was assessed through a five-point Likert scale. Descriptive statistics were conducted for all questionnaire items and qualitative data was examined using content analysis. The majority of patients (73%) were counseled on their medication(s) before leaving the hospital. Among those who received counseling, 76 patients had a better understanding of their medication(s). Ninety-five percent of the patients reported adherence, and all six of the patients reporting non-adherence claimed they were not counseled on their medications prior to discharge. Many patients had questions regarding their medication during the follow-up phone call, substantiating the need for further follow-up with patients once they have left the hospital environment. The implementation of medication bedside delivery and counseling services, followed by outpatient adherence monitoring via a transitional care management service, can result in higher levels of reported medication adherence.

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“…17,26 Multiple reports have demonstrated that medication adherence is important for readmission prevention. 14,18,21,28,40,41,43 The experience of participating surgeons was that noncompliance with medication regimens, potentially due to inadequate education, was a driver of readmission on the neurosurgical service. Therefore, a list of important medications was identified and delivered to patients prior to discharge, which may have lessened avoidable readmissions because of noncompliance.…”

Section: Discussionmentioning

confidence: 99%

“…These results align with previous reports that pharmacy assistance and education, as well as posthospitalization surveillance, aid in reducing avoidable readmissions. 14,18,21,28,40,41,43 The quality improvement seen with the TCP was multifaceted. The team included educational consultants, digital media experts, nurses, pharmacists, physician assistants, physicians, and hospital administrators.…”

Section: Discussionmentioning

confidence: 99%

Transitional care services: a quality and safety process improvement program in neurosurgery

Robertson

Logsdon

Dasenbrock

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Readmissions increasingly serve as a metric of hospital performance, inviting quality improvement initiatives in both medicine and surgery. However, few readmission reduction programs have targeted surgical patient populations. The objective of this study was to establish a transitional care program (TCP) with the goal of decreasing length of stay (LOS), improving discharge efficiency, and reducing readmissions of neurosurgical patients by optimizing patient education and postdischarge surveillance. METHODS Patients undergoing elective cranial or spinal neurosurgery performed by one of 5 participating surgeons at a quaternary care hospital were enrolled into a multifaceted intervention. A preadmission overview and establishment of an anticipated discharge date were both intended to set patient expectations for a shorter hospitalization. At discharge, in-hospital prescription filling was provided to facilitate medication compliance. Extended discharge appointments with a neurosurgery TCP-trained nurse emphasized postoperative activity, medications, incisional care, nutrition, signs that merit return to medical attention, and follow-up appointments. Finally, patients received a surveillance phone call 48 hours after discharge. Eligible patients omitted due to staff limitations were selected as controls. Patients were matched by sex, age, and operation type-key confounding variables-with control patients, who were eligible patients treated at the same time period but not enrolled in the TCP due to staff limitation. Multivariable logistic regression evaluated the association of TCP enrollment with discharge time and readmission, and linear regression with LOS. Covariates included matching criteria and Charlson Comorbidity Index scores. RESULTS Between 2013 and 2015, 416 patients were enrolled in the program and matched to a control. The median patient age was 55 years (interquartile range 44.5-65 years); 58.4% were male. The majority of enrolled patients underwent spine surgery (59.4%, compared with 40.6% undergoing cranial surgery). Hospitalizations averaged 62.1 hours for TCP patients versus 79.6 hours for controls (a 16.40% reduction, 95% CI 9.30%-23.49%; p < 0.001). The intervention was associated with a higher proportion of morning discharges, which was intended to free beds for afternoon admissions and improve patient flow (OR 3.13, 95% CI 2.27-4.30; p < 0.001), and decreased 30-day readmissions (2.5% vs 5.8%; OR 2.43, 95% CI 1.14-5.27; p = 0.02). CONCLUSIONS This neurosurgical TCP was associated with a significantly shorter LOS, earlier discharge, and reduced 30-day readmission after elective neurosurgery. These results underscore the importance of patient education and surveillance after hospital discharge.

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Implementation of transitions-of-care services through acute care and outpatient pharmacy collaboration

Cited by 31 publications

References 6 publications

Interventions to address medication-related causes of hospital readmissions: A scoping review

Interventions to address medication-related causes of hospital readmissions: A scoping review

Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

Transitional care services: a quality and safety process improvement program in neurosurgery

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