Reduced Drug Use and Hospitalization Rates in Patients Undergoing Hemodialysis Who Received Pharmaceutical Care: A 2‐Year, Randomized, Controlled Study

Pai, Amy Barton; Boyd, Alex; Depczynski, Joseph; Chavez, Isela Martinez; Khan, Nasreen; Manley, Harold J.

doi:10.1592/phco.29.12.1433

Cited by 89 publications

(64 citation statements)

References 11 publications

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“…This result suggests that more than 70% of MRPs could be addressed by systematic MTM at the dialysis facility during routine care and at transition back to the dialysis facility, potentially preventing readmission. In a 2-year randomized, controlled trial of 104 hemodialysis patients assigned to receive pharmaceutical care (in-depth bimonthly medication therapy reviews conducted by a clinical pharmacist) or usual care (brief medication therapy reviews conducted by nurse), the former was associated with fewer hospitalizations (1.862.4 versus 3.163, P50.02); the trend for reduced lengths of stay did not achieve statistical significance (9.7614.7 versus 15.5616.3 days, P50.06) (11). A recent study showed that integrated pharmacy services in hemodialysis patients receiving Medicare and Medicaid were associated with lower rates of death and hospitalization (35).…”

Section: Significant Total Cost Of Care Savings Could Be Realized Thrmentioning

confidence: 99%

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Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Pai

Cardone

Manley

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPatients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.

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Section: Significant Total Cost Of Care Savings Could Be Realized Thrmentioning

confidence: 99%

“…Not surprisingly, several studies have shown a high prevalence rate of MRPs in patients undergoing maintenance dialysis (6,(10)(11)(12) (Table 2).…”

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Pai

Cardone

Manley

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Mortality is increased on the first day back after the long interdialytic interval of the weekend, 7 which fueled the suggestion that more frequent treatments with narrower shifts in…”

Section: Disclosuresmentioning

confidence: 99%

“…The involvement of pharmacists has been shown to not only identify actual and potential MRPs, but to reduce rehospitalizations and lengths of stay of dialysis patients. 7,8 In another common scenario, the ESRD patient is admitted for an infectious cause or sepsis, receives appropriate intravenous antibiotics after positive wound or blood cultures, and is discharged as soon as clinical symptoms improve, with the presumption that the same antibiotic regimen can be continued in the dialysis unit. Unfortunately, in many cases, the information about the specific intravenous antibiotic is not transmitted to the dialysis facility in time for the facility to order the antibiotics.…”

mentioning

confidence: 99%

Reducing Avoidable Rehospitalization in ESRD

Hakim

Collins

2014

Journal of the American Society of Nephrology

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This program was based on a study of rehospitalization rates by Jencks et al., 2 which highlighted inadequate care coordination by hospitals in Medicare patient hospital discharges, resulting in an approximately 20% readmission rate within 30 days of discharge. The Readmission Reduction Program established a Medicare diagnosis-related group (DRG) payment reduction for hospitals that exceeded the adjusted national average readmission rate for three diagnoses: acute myocardial infarction, congestive heart failure, and pneumonia. For fiscal year 2013, the potential reduction was up to 2% of the following year's total DRG payments, and a further reduction of up to 3% of total DRG payments in fiscal year 2014.Application of the high readmission penalty specifically to the dialysis population has also been proposed, based on the high rate of readmission noted by Jencks et al. 2 and data reported by the US Renal Data System showing an overall rehospitalization rate for patients with ESRD of 34% within 30 days of discharge. 3 This 70% higher rate of hospital readmission brought readmissions of the dialysis population into consideration for a quality metric of the Quality Improvement Program, which can affect up to 2% of the Prospective Payment System for dialysis. 1 The study by Erickson et al. 4 in this issue of JASN highlights the potential relationship between the rate of readmission of dialysis patients and the frequency of face-to-face health care provider (physician and/or advanced practitioner) visits at the dialysis facility in the month after hospital discharge. The mean number of provider-patient interactions among patients who were rehospitalized or died within 30 days of a hospital discharge was 2.161.6 episodes, significantly below the frequency of 3.361.2 episodes among patients who were not rehospitalized and did not die within 30 days of discharge. Among patients who were not rehospitalized, close to 65% were seen $4 times during those 30 days compared with 32.4% of rehospitalized patients. Instrumental variable regression analysis estimated that one additional provider visit (compared with the average of 2.861.5 provider visits per month) may reduce the probability of rehospitalization by an absolute difference of 3.5%, or a relative reduction of 9.7% in the rate of rehospitalization. The authors further highlight the resulting economic health care benefits of an additional provider visit in the 30 days after hospitalization, which they estimate conservatively to be .$240 million in aggregate cost savings to Medicare funds.It is evident that the increased frequency of nephrologist visits to the dialysis unit can be optimized with essential information from the discharging hospital, and timing of the additional visit based on the physician's rounding schedule can be optimized by coordination with the discharge event. However, the association noted by Erickson et al. 4 should be considered in any plan to reduce rehospitalizations in the dialysis population.Maximizing the benefit of increased physician vi...

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“…Most of the pharmacist interventions involved medication profile reviews to address drug-related problems such as dosage adjustments related to renal function, making recommendations to the physicians, adjusting medications to optimize drug therapy, performing laboratory monitoring of specific parameters, and medication education. In a 2-year randomized controlled study [31] of patients undergoing hemodialysis, the intervention group involved in-depth one-on-one drug reviews with a pharmacist. This group compared to usual care contributed to a significant average reduction in all-cause hospitalizations.…”

Section: Evidence Supporting Improved Cardiovascular and Kidney Outcomentioning

confidence: 99%

The Role of Team-Based Care Involving Pharmacists to Improve Cardiovascular and Renal Outcomes

Odum

Whaley‐Connell²

2012

Cardiorenal Med

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The number of patients with cardiovascular and kidney disease in the United States continues to grow as the population ages, increasing the demand on the health care system and its providers. Many patients develop chronic conditions in which optimization of care is labor intensive, specifically hypertension, hyperlipidemia, diabetes, heart failure, and chronic kidney disease. Therefore, innovative and collaborative approaches to health care are warranted. Several team-based health care models have evolved and are gaining popularity, including the Patient-Centered Medical Home (PCMH) and Medication Therapy Management (MTM). Team-based care is widely supported in the literature, demonstrating significant improvement in cardiovascular and renal outcomes. This article will review the premises of PCMH and MTM, review the evidence and roles for team-based care specific to cardiovascular and renal outcomes, and introduce fundamentals to implement collaborative practice focusing on pharmacist-provider teams.

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Reduced Drug Use and Hospitalization Rates in Patients Undergoing Hemodialysis Who Received Pharmaceutical Care: A 2‐Year, Randomized, Controlled Study

Cited by 89 publications

References 11 publications

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Reducing Avoidable Rehospitalization in ESRD

The Role of Team-Based Care Involving Pharmacists to Improve Cardiovascular and Renal Outcomes

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