Reducing 30-day Readmission Rates Through Compliance Calls Post-Discharge

EDITOR’S NOTE: The discharge pharmacy service discussed in this article was initiated by the author and colleagues. Their research was presented during a poster session at the ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition in Las Vegas, Nevada.

Discharge counselling has reduced medication error, and subsequent readmission rates due to medication adherence, and thus improved quality of life, and health outcomes.¹ In fact, medication noncompliance has been directly correlated with disease progression, and hospital readmissions.^2-3

The discharge pharmacy service at West Virginia University (WVU) Medicine in Morgantown was initiated by pharmacy professionals in October 2012. Our discharge program is intended to be a ‘patient first’ program that ensures patients receive the medications prescribed in hand, and that they remain adherent through medication counseling and followup. The goal was to expand our services from the outpatient pharmacy to patients hospitalized at WVU Medicine, which included offering post-discharge medication delivery, and consultation, and to improve facility satisfaction scores and reduce 30-day readmissions.

Method

We follow diagnoses that are at high-risk of being readmitted∙

• Pneumonia (CAP)
• COPD
• Heart attack (AMI)
• Diabetes
• Heart Failure (CHF)
• Elective surgery

Our discharge pharmacy service identifies patients at high risk, offers 'meds to beds' service upon discharge, gets consent from the patient, and facilitates getting the discharge medication orders to the pharmacy. The program also processes medications, identifies time of discharge, dispenses medications, counsels patients at their bedsides, and initiates compliance calls.

Continuity of care through medication reconciliation has been a continual focus in both inpatient and outpatient pharmacy. Part of the reconciliation process that has shown improved patient outcomes corresponding with bedside medication delivery at the time of discharge. Studies have shown improved compliance, and a reduction in medication adverse events when reconciliation is done at the time that prescriptions are dispensed, prior to discharge.

The purpose of our discharge pharmacy service is to improve quality of patient care by eliminating barriers that delay or prevent filling of discharge prescriptions, and widening access to outpatient prescriptions. The program’s focus is to ensure adherence through a comprehensive follow-up phone call post discharge. Compliance calls can evaluate discharge processes and workflow, identify issues and concerns, allow for patient questions, and assess understanding by open ended questions.

Result

• Approximately 1 in 5 patients are readmitted depending on disease state
• ~20% of patients do not get their medications filled
• ~30-40% are not adherent with their meds
• 72% of patients' readmittance is due to their medication regimen.^4-5

Patients were asked if a follow-up phone call was allowed 30 days post discharge. Patients consenting to the outreach were attempted to be contacted to determine if the medication regimen was changed post discharge, the patient’s adherence to current regimen, and timeliness of delivery to bedside. Other criteria included whether counseling was performed, quality of discharge pharmacy service, and source of how the patient became aware of the program.

Over a 3-month period, 216 patients entered the study, of which 194 patients we able to be reached by phone. The results showed that approximately 62% of patients got their medications filled through the discharge program. The patients that consented to service that were not served showed that the major reasons included the discharge disposition, with most of the patient’s status going to a skilled nursing facility and long-term acute care. A small percentage of patients received no new medications being prescribed upon discharge.

Conclusion

Results found more than 91% of patients remained adherent to the same medication regimen 30 days form discharge. Almost 94% of patients stated that their medication was delivered to bedside in a timely fashion at time of discharge. Almost 75% of patients reported being given medication counseling, and the source of that counseling coming from nursing.⁶

Searching for the source of who offered the 'meds to meds' program showed the majority coming from the pharmacy staff, both inpatient and outpatient. The evidence confirms the majority of patients preferred to utilize the follow up consultation. An overwhelming 89.8% of patients that were offered the service chose to use it. Around 75% of patients that used the service benefited from medication counseling.⁶

REFERENCES

• Bonetti AF et al. Pharmacist-led discharge medication counselling: A scoping review. J Eval Clin Pract. 24 (3): 570-579; 2018.
• Malek N et al. A review of medication adherence in people with epilepsy. Acta Neurol Scand. 135 (5): 507-515; 2016.
• Acharya T et al. Poor compliance as a sign of depression: Why might an elderly man stop his medication? Psychiatr Danub. 30 (Suppl 7): 630-632; 2018. https://www.ncbi.nlm.nih.gov/pubmed/30439861
• 30-Day Readmission Rates to the U.S. Hospitals. 2010. HCUP Statistical Briefs, #153, 15 04 July 19. www.HCUP-US.ahrq.gov/reports/statbriefs/statbriefs.jsp
• Trinkley, K.E., Deng, B., Kroehl, M.E., et al. 2017. Improving Post Discharge Medication Adherence: A collaboration between an Academic Medical Center and a Community Pharmacy Chain. Pulsus Journal. 116-120.
• Calemine L, et al. New steps to reduce 30-day readmission rates through discharge counseling and follow-up phone calls in a meds-to-beds program. Presented at: ASHP 54th Midyear Clinical Meeting and Exhibition; Las Vegas, NV. December 9, 2019.