The Effectiveness of Pharmacist-Provided Telephonic Medication Therapy Management on Emergency Department Utilization in Home Health Patients

Abstract

Background: Preventable emergency department (ED) use may be targeted with interventions for improving the medication use process, as medication misadventures and nonadherence frequently cause preventable ED utilization. One intervention that could prevent ED visits is medication therapy management (MTM). Objective: To evaluate the effectiveness of a telephonic MTM service on reducing ED utilization within a Medicare-insured home health population. Methods: This was a secondary analysis of data from a cluster-randomized controlled trial examining hospitalizations among Medicare-insured patients within 40 randomly selected, geographically diverse, home health centers. The intervention consisted of an initial telephonic medication reconciliation with a pharmacy technician, a telephonic pharmacist-provided medication review, and follow-up pharmacist phone calls. The primary outcome of this analysis was 60-day all-cause ED utilization. Patients’ baseline risk of ED utilization was calculated, and patients were stratified into quartiles based on their baseline risk of ED utilization. Adjusted odd ratios of ED utilization were calculated. Results: Data from 656 patients (intervention n = 297, usual care n = 359) were available for this study. Overall, the MTM intervention was not associated with 60-day ED use, as 24.4% of intervention patients and 25.1% of usual care patients utilized the ED (adjusted odds ratio = 1.11; 95% confidence interval = 0.79-1.57). However, there was lower ED utilization among patients in the lowest risk-quartile (adjusted odds ratio = 2.52; 95% confidence interval = 1.15-5.49; P = .02). Conclusion: This pharmacist-delivered telephonic MTM program did not decrease ED utilization overall in a Medicare-insured home health population, but may further reduce the risk of ED utilization among patients who are at lower risk of utilization.

Digital Health Interventions by Clinical Pharmacists: A Systematic Review

“…Specifically, no significant differences were reported between these two groups in these studies with respect to the proportion of individuals who attempted tobacco cessation among tobacco users [ 22 ], adherence to cancer drug for almost all cycles, overall survival (OS), and progression-free survival (PFS) among individuals with metastatic colorectal or gastric cancer [ 23 ], changes in HbA1c level and adherence to diabetic drugs [ 24 ], adherence to cardiovascular drugs and the percent of those with LDL-C goal achievement among individuals with coronary heart disease (CHD) [ 25 ], and the proportion of emergency department (ED) visits and readmission to hospital within 30 days of discharge among those with cancer [ 26 ]. Five studies revealed inconsistent effects of phone intervention on patients’ outcomes [ 27 , 28 , 29 , 30 , 31 ]. In other words, the interventions in each of these studies resulted in improvement in some outcomes, but not in others.…”

“…Similarly, Choudhry reported that phone-based consultation resulted in improvement in medication adherence, but the impacts of this phone intervention on disease control based on LDL, sBP, HbA1c, hospitalization, and physician office visits were not significant [ 29 ]. Gernant et al revealed no significant differences in 60-day ED utilization between the treatment group receiving phone-based MTM services and the control group receiving usual nursing care, but reported significantly lower ED use among individuals in the lowest risk quartile in the treatment group compared to the control group [ 30 ]. Zillich et al also demonstrated no significant differences in 30-day and 60-day hospitalizations between the phone-based MTM group and the usual home care group, but found significantly lower 30-day and 60-day hospitalizations among those in the lowest risk quartile in the treatment group [ 31 ].…”

Motion Artifact Reduction in Electrocardiogram Signals Through a Redundant Denoising Independent Component Analysis Method for Wearable Health Care Monitoring Systems: Algorithm Development and Validation

“…Digital health provides the opportunity to combat pandemics, to deliver health care in remote regions, and to reduce the carbon footprint of health care delivery. Telehealth and remote monitoring, particularly in patients’ homes, has become an important option due to problems associated with keeping patients in hospitals and care centers for extended periods: the increase in the probability of acquiring nosocomial infections [ 1 ]; the deficiency in medical infrastructure to meet the demand of patients [ 2 ]; the increase in therapeutic dependence by older adult patients [ 3 ]; and the increase in hospitalization costs. These issues have led to a search for alternatives in medical care such as home health care.…”

The Impact of Pharmacy-specific Predictors on the Performance of 30-Day Readmission Risk Prediction Models

“…Pharmacist-led interventions during transitions of care have shown potential in reducing hospital readmission rates [2][3][4][5][6][7][8] and medication errors 9,10 . These pharmacist-led interventions include medication reconciliation 8,10 , complete medication reviews during admission 7,8 and medication therapy management programs after discharge 11,12 . Such interventions have become common in health organizations seeking to reduce their readmission rates 13 .…”