Utilization of a multidisciplinary team to reduce the rate of hospital readmissions in high‐risk heart failure patients at a community teaching hospital: The pharmacist's role in transitions of care

Abstract

Introduction Since the implementation of the Hospital Readmission Reduction Program, health systems have been working to reduce hospital readmission rates of patients with heart failure (HF). Of these efforts, the interventions with a multidisciplinary, multicomponent approach have lowered readmission rates as well as improved patient care, patient adherence, and patient outcomes. Objectives The primary objective of this study was to determine if the addition of a pharmacist to the Transitional Care Team (TCT) would decrease the number of high‐risk HF patients readmitted to the hospital before 30 days. Secondarily, this study assessed the change in self‐reported medication adherence. Methods This study was conducted at a community teaching hospital. A retrospective chart review was performed to identify HF patients who were at high risk for readmission admitted to the hospital from May 2012 to October 2013, as the historical control group. The intervention group included high‐risk patients with HF admitted from May 2014 to October 2015, who received the pharmacist‐led intervention during hospitalization and postdischarge. The pharmacist‐led intervention comprised five components: medication reconciliation, medication cost/formulary review, medication discharge counseling, providing and educating patients regarding self‐monitoring resources and postdischarge telephone follow‐up. The 8‐item Morisky Medication Adherence Scale was used to measure patients' self‐reported medication adherence at baseline, then 30 days after discharge. Results The pharmacist‐led intervention assisted in decreasing the readmission rate from 33.7% in the historical control group to 21.3% in the intervention group with a relative risk reduction of 0.696 (confidence interval: 0.488‐0.994). There was also a significant improvement in self‐reported patient medication adherence scores. Conclusion The addition of a pharmacist to the TCT that managed HF patients was associated with a decrease in the readmission rate for patients who were at high risk of readmission and improved self‐reported patient medication adherence.

Role of clinical pharmacists and pharmacy support personnel in transitions of care

“…An institution may initially consider targeting certain patient groups with documentation in improved patient outcomes after TOC services. Examples of such groups include patients with high readmission risk disease, such as those included in the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP); patients taking high‐risk medications or a high volume of prescriptions; and patients in high‐risk or time‐pivotal departments, such as the ED . Although all patients in the hospital should ideally receive TOC services provided by a pharmacist, identification of key target populations can be vital when resources and personnel are limited.…”

“…Pharmacist activities during follow‐up calls and visits should be documented, shared, and coordinated with a billing provider for TCM. In addition to contributing to billable TCM, clinic‐based pharmacists can justify their services with other financial metrics such as cost‐avoidance or cost‐savings data related to reduced readmissions and identification and resolution of medication‐related problems …”

“…Many programs target high‐risk discharge conditions identified in the CMS HRRP . For example, Thurston and coworkers showed that hospital readmissions for high‐risk patients with heart failure were reduced from 33.7% to 21.3% (relative risk [RR] 0.696; 95% confidence interval [CI], 0.488‐0.994) through a multicomponent pharmacist‐led intervention . Other programs identifying high‐risk patients on the basis of targeted medications or number of discharge prescriptions (eg, three or more new medications) found that pharmacist‐provided TOC activities reduced readmissions from 39% to 24.8% ( P = .01), with a nonstatistically significant reduction in adverse drug events and improvement in HCAHPS scores .…”

“…28 SafeMed is an innovative program that uses pharmacy technicians as community health workers to identify medication-related problems through home visits and telephone follow-ups after hospital discharge. 29 41 ; patients taking high-risk medications or a high volume of prescriptions 38 ; and patients in high-risk or time-pivotal departments, such as the ED. 30 Although all patients in the hospital should ideally receive TOC services provided by a pharmacist, identification of key target populations can be vital when resources and personnel are limited.…”

“…In one such example, the Cystic Fibrosis (CF) Foundation developed recent funding mechanisms to promote the addition of pharmacists and pharmacy technicians in CF care centers. 62 In addition to supporting the clinical pharmacist's role in CF clinics, such funding helps support the addition of pharmacy techni- 41 Other programs identifying high-risk patients on the basis of targeted medications or number of discharge prescriptions (eg, three or more new medications) found that pharmacist-provided TOC activities reduced readmissions from 39% to 24.8% (P = .01), with a nonstatistically significant reduction in adverse drug events and improvement in HCAHPS scores. 38 Examples of validated instruments that aid in risk stratification include the fourfactor LACE score (length of stay, acuity of admission, comorbidities, and ED visits) and the 8-point screening tool based on the Better Outcomes for Adults through Safe Transitions (BOOST) project.…”