Pharmacist Recommendations Reduce Costly Heart Failure Readmissions

High hospital readmission rates plague the health care system. In fact, studies have demonstrated that 1 in 5 Medicare patients are readmitted within 30 days of discharge.

Factors such as communication glitches with outpatient providers and poor follow-up contribute to “revolving door” readmissions, which cost the United States an estimated $25 billion annually.

In light of this, the US Centers for Medicare and Medicaid Services financially penalizes hospitals with readmission rates above the national average for specific diseases, including heart failure (HF) and chronic obstructive pulmonary disease (COPD). Accordingly, hospital-to-home transitions of care (TOC) interventions that improve care quality and patient satisfaction while decreasing readmission rates are high priority.

Since approximately 20% of discharged patients report experiencing at least 1 medication-related problem, experts speculate that community pharmacists’ medication therapy management (MTM) services may effectively reduce readmissions. Pharmacists at the University of Cincinnati set out to quantify this hypothesis in a study published in the June 2015 issue of the Journal of American Pharmacists Association.

The pharmacists evaluated a total of 90 patients discharged from either of 2 community hospitals in western Cincinnati, Ohio. HF patients dominated the MTM intervention arm, accounting for 17 of the 30 patients, with the remainder including 8 pneumonia patients and 5 COPD patients. The usual care arm included 13 pneumonia patients, 23 HF patients, and 24 COPD patients.

Hospital staff reconciled medications for all patients at discharge. Outpatient MTM appointments were 30 to 60 minutes in length, depending on patient complexity, and they included comprehensive medication review and disease and self-management education.

Frequent pharmacist recommendations included self-care modifications that promoted patient self-management, such as daily weight and blood pressure monitoring in HF patients. Recommendations for additional therapy were also common, most of which were condition-specific and outlined in evidence-based guidelines. Many pharmacist recommendations promoted vaccination.

Through the TOC interventions, community pharmacists successfully improved patients’ medication adherence and self-monitoring habits while maintaining similar overall patient satisfaction. At the study’s completion, about 1 in 5 patients in the usual care arm were readmitted within 30 days, compared with only 6.9% of the pharmacist intervention arm.