A pharmacist-managed transitions of care program significantly reduced 30-day all-cause hospital readmissions to 8.1% compared to 27.5% in patients who did not receive pharmacist follow-up.
Observational (n=139)
No
Does a pharmacist-managed transitions of care program reduce 30-day readmissions and ED visits in high-risk patients discharged to the community?
A pharmacist-managed transitions of care program significantly reduced 30-day all-cause and index hospital readmissions among high-risk veterans discharged to the community.
Absolute Event Rate: 8.1% vs 27.5%
p-value: p=.03
PURPOSE: To improve, expand, and sustain a pharmacist-based transitions of care (TOC) program and to assess interventions targeting veterans at high risk for adverse outcomes. METHODS: A TOC program was developed and piloted at the Richard L. Roudebush Veterans Affairs Medical Center (RLRVAMC). Following success of the pilot project, targeted interventions were identified to improve and expand the program. Patients deemed high risk for readmission by an acute care pharmacist were identified and referred for continued postdischarge follow-up. The study population included patients discharged to the community with primary care established within the RLRVAMC system. Eligible patients were entered into a TOC database by the referring acute care pharmacist. A pharmacist in the primary care clinic reviewed then contacted the patient within 1 week of discharge. Appropriate documentation of each visit was completed in the electronic health record. Data collection included background information, time to follow-up, medication discrepancies, pharmacist interventions, emergency department visits, and hospital readmissions. RESULTS: = .03) at 30 days compared with those who did not received pharmacist follow-up, respectively. CONCLUSIONS: This study demonstrated that implementation and expansion of a pharmacist-based TOC process is effective in communicating high-risk patients and intervening on medication-related issues postdischarge.
Jasmine Coatie (2021) conducted an observational in High risk for hospital readmission (n=139). Pharmacist-managed transitions of care (TOC) follow-up vs. No pharmacist follow-up (unable to be reached) was evaluated on 30-day all-cause readmission (p=.03). A pharmacist-managed transitions of care program significantly reduced 30-day all-cause hospital readmissions to 8.1% compared to 27.5% in patients who did not receive pharmacist follow-up.