Key result
A pharmacist/clinician collaborative postdischarge visit significantly decreased total costs in the 10th and 90th cost quantiles at 30 days, and in the 25th, 50th, and 75th quantiles at 180 days.
Why the study?
To evaluate the impact of a collaborative pharmacist and primary care clinician intervention on postdischarge total cost of care in patients at high risk for readmission due to polypharmacy.
Does a pharmacist/clinician collaborative postdischarge visit reduce total cost of care in adult patients with polypharmacy at high risk for readmission?
Cohort (n=996)
No
Does a pharmacist/clinician collaborative postdischarge visit reduce total cost of care in adult patients with polypharmacy at high risk for readmission?
A collaborative postdischarge visit involving a pharmacist and primary care clinician significantly reduces total cost of care across various cost quantiles up to 180 days in medically complex patients with polypharmacy.
May support pharmacist-clinician postdischarge visits for cost reduction; hypothesis-generating and requires randomized confirmation before practice change.
PURPOSE: To evaluate the impact of a collaborative intervention by pharmacists and primary care clinicians on total cost of care, including costs of inpatient readmissions, emergency department visits, and outpatient care, at 30, 60, and 180 days after hospital discharge in a population of patients at high risk for readmission due to polypharmacy. METHODS: A retrospective study of cost outcomes in a cohort of adult patients discharged from a single institution from July 1, 2013 to March 25, 2016, was conducted. All patients had at least 10 medications listed on their discharge list, including at least 1 drug frequently associated with adverse events leading to hospital readmission. About half of the cohort (n = 496) attended a postdischarge visit involving both a pharmacist and a primary care clinician (a physician, physician assistant, or licensed nurse practitioner); this was designated the pharmacist/clinician collaborative (PCC) group. The remainder of the cohort (n = 500) attended a visit without pharmacist involvement; this was designated as the usual care (UC) group. Costs were compared using a quantile regression to assess the potential heterogeneous impacts of the PCC intervention across different parts of the cost distribution. All outcomes were adjusted for differences in baseline characteristics. RESULTS: At 30 days post index discharge, there was a significant decrease in total costs in the 10th and 90th cost quantiles in the PCC cohort vs the UC cohort, without a statistically significant decrease in the 25th, 50th or 75th quantiles. The difference was significant in the 75th and 90th quantiles at 60 days and in the 25th, 50th, and 75th quantiles at 180 days. There was a nonsignificant cost reduction in all other quantiles. CONCLUSION: Medically complex patients had a significantly lower total cost of care in approximately half of the adjusted cost quantiles at 30, 60, and 180 days after hospital discharge when they had a PCC visit. PCC visits can improve patient clinical outcomes while improving cost metrics.
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Herges et al. (2020) conducted a cohort in Polypharmacy (n=996). Pharmacist/clinician collaborative (PCC) postdischarge visit vs. Usual care (visit without pharmacist involvement) was evaluated on Total cost of care at 30, 60, and 180 days after hospital discharge. A pharmacist/clinician collaborative postdischarge visit significantly decreased total costs in the 10th and 90th cost quantiles at 30 days, and in the 25th, 50th, and 75th quantiles at 180 days.
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