Key result
A clinical pharmacist intervention at discharge for polymedicated older adults reduced 30-day readmissions from 20.13% to 16.43% (OR 0.760), though this reduction was not statistically significant.
Why the study?
Patient education on pharmacological treatment could reduce readmissions, motivating an evaluation of a pharmacist intervention focused on high-risk medications regarding readmissions and costs.
Does a pharmacist intervention at discharge reduce 30-day readmissions and costs in elderly polymedicated patients admitted to internal medicine?
Cohort (n=589)
No
Does a pharmacist intervention at discharge reduce 30-day readmissions and costs in elderly polymedicated patients admitted to internal medicine?
Odds Ratio: 0.76 (95% CI 0.495–1.166)
Absolute Event Rate: 16.43% vs 20.13%
Absolute Risk Reduction: 3.7%
Number Needed to Treat: 27
p-value: p=0.209
A pharmacist intervention at discharge for elderly polymedicated patients showed a non-significant reduction in 30-day readmissions but achieved net cost savings, particularly in intermediate and high-risk patients.
Pharmacist-led discharge education may cut readmissions and costs in higher-risk elderly patients; leaves open efficacy in routine care without RCTs.
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.
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Cebas et al. (2022) conducted a cohort in Polymedicated elderly patients admitted to internal medicine (n=589). Clinical pharmacist intervention providing information on high-risk medications vs. Retrospective usual care was evaluated on 30-day all-cause hospital readmission (OR 0.760, 95% CI 0.495-1.166, p=0.209). A clinical pharmacist intervention at discharge for polymedicated older adults reduced 30-day readmissions from 20.13% to 16.43% (OR 0.760), though this reduction was not statistically significant.
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