Impact of pharmacist-led medication management in care transitions

Background: When patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients' medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients' medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions. Methods: This was a case-cohort study conducted in two acute hospitals in the UK. Pharmacists performed a telephone follow-up intervention to discharged patients to provide medicines management support. Patients who received pharmacist telephone follow-up calls within 14 days of discharge formed the intervention group. A subset of medical patient population discharged in the month of May 2013 formed the comparison group. During a series of two-telephone follow-up, pharmacists identified post-discharge pharmaceutical problems and provided patient-tailored interventions accordingly. The impact of pharmacist interventions was assessed using a risk assessment matrix tool by two senior pharmacists. Overall 30-day readmission rates in the intervention group were measured and compared with the comparison group using a chi-square test. Results: Between 5th and 25th June 2013, a total of 62 medical patients participated in the study. Pharmacists provided 192 interventions as a result of pharmacist telephone follow-up intervention. The most prevalent type of interventions was the provision of drug information (n=40), followed by screening patient adherence (n=30) and advising on adverse drug reactions (n=27). The impact of interventions was assessed, and 49.3% of the identified risks intervened by pharmacists were associated with moderate risk. The 30-day readmission rates in the intervention group were 11.3% compared to 9.0% in the control group (p = 0.376); this was not statistically significant. Conclusions: A pharmacist TFU intervention did not show a benefit in 30-day hospital readmissions. However, a pharmacist TFU intervention was an effective method to solve or avoid critical pharmaceutical problems. A future study using a larger scale trial is warranted.