Intervention by a clinical pharmacist carried out at discharge of elderly patients admitted to the internal medicine department: influence on readmissions and costs

Abstract

Background Patient education on pharmacological treatment could reduce readmissions. Our objective was to carry out a pharmacist intervention focused on providing information about high-risk medications to chronic patients and to analyse its influence on readmissions and costs. Methods A single-centre study with an intervention group and a retrospective control group was conducted. The intervention was carried out in all polymedicated patients ≥ 65 years who were admitted to internal medicine and signed the informed consent between June 2017 and February 2018. Patients discharged to nursing homes or long-term hospitals were excluded. The control group were all the patients who were admitted during the same months of 2014 who met the same inclusion criteria. The patients were classified according to the HOSPITAL score as having a low, intermediate, or high risk of potentially avoidable readmission. Outcome measures were 30-day readmission and cost data. To analyse the effect of the intervention on readmission, a logistic regression was performed. Results The study included 589 patients (286 intervention group; 303 control group). The readmission rate decreased from 20.13% to 16.43% in the intervention group [OR = 0.760 95% CI (0.495–1.166); p = 0.209)]. The incremental cost for the intervention to prevent one readmission was €3,091.19, and the net cost saving was €1,301.26. In the intermediate- and high-risk groups, readmissions were reduced 10.91% and 10.00%, and the net cost savings were €3,3143.15 and €3,248.71, respectively. Conclusions The pharmacist intervention achieved savings in the number of readmissions, and the net cost savings were greater in patients with intermediate and high risks of potentially avoidable readmission according to the HOSPITAL score.

Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review

“…First, telephone-based interventions were generally found to be costeffective in the studies included in this review. That is, five out of the seven phone-based studies revealed the economic benefits of the phone interventions [32,33,35,36,38]. In the other two telephone-based studies by Pyne et al and Painter et al [19,20], the authors concluded that the interventions were not cost-effective because the ICERs of the interventions were higher than the conventionally cited WTP thresholds of USD 50,000-USD 150,000/QALY.…”

“…Of these 14 studies, pharmacists used a telephone-based intervention in seven. Five out of the seven studies reported the economic benefits of the phone interventions [32,33,35,36,38]. Dehmar et al's CEA study revealed that home blood pressure monitoring and pharmacist case management improved hypertension care in a cost-effective manner [35].…”

“…They reported an incremental cost-effectiveness ratio (ICER) of SAR 2373 per 1% reduction in HbA1c. In a CBA study with polymedicated elderly patients admitted to an internal medicine ward, a clinical pharmacist carried out phone-based follow-up interventions after patients' discharge [36]. The interventions achieved a net cost saving of EUR 1301 by reducing readmissions of these patients.…”

Impact of internal medicine pharmacists on antimicrobial stewardship

“…While formalized AMS education or certification is not standard during training for IM pharmacists, they regularly manage antimicrobials for urinary tract infections, lower respiratory tract infections, skin and skin structure infections, and bloodstream infections. While the overall utility of IM pharmacists as a part of the health care team is described within the literature, less is documented about their impact on AMS initiatives and any barriers they encounter to their interventions 16,21–24 . This study was conducted to characterize AMS interventions made by IM pharmacists and their trainees.…”

“…While the overall utility of IM pharmacists as a part of the health care team is described within the literature, less is documented about their impact on AMS initiatives and any barriers they encounter to their interventions. 16,[21][22][23][24] This study was conducted to characterize AMS interventions made by IM pharmacists and their trainees.…”