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Evaluation of a Pharmacy-Driven Inpatient Discharge Counseling Service: Impact on 30-Day Readmission Rates

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OBJECTIVE: To evaluate the impact of a pharmacy-driven inpatient discharge counseling service on 30-day readmission rates.

DESIGN: A retrospective electronic chart review was performed comparing internal medicine patients who received pharmacy discharge counseling with those who received the standard discharge process between May 1, 2011, and March 28, 2012.

SETTING: A community teaching hospital's internal medicine service.

PATIENTS: A total of 1,536 patients discharged from the internal medicine service were eligible for study inclusion. A total of 228 of these patients received pharmacy discharge counseling.

INTERVENTIONS: Patients were screened for readmission risk. For those patients who scored as high risk, an attempt was made to provide pharmacy counseling and a discharge medication list.

MAIN OUTCOMES MEASURES: The primary endpoint was to evaluate whether pharmacy discharge counseling had an impact on readmission rates. An additional outcome was to measure the quantity of pharmacy interventions.

RESULTS: Out of the 228 patients who received pharmacy discharge counseling, 18.9% were readmitted within 30 days of hospital discharge, which was similar to the readmission rate for high- and moderate-risk patients who did not receive counseling (18.8% and 18.9%, respectively). But, after stratification based on readmission risk, the moderate-risk, pharmacy-counseled group had a significantly lower readmission rate than the moderate-risk control group (3.8% vs. 18.9%; P = 0.033). Overall, 915 pharmacist interventions were made, averaging 4 interventions per patient. CONCLUSIONS: Pharmacy discharge counseling was associated with reduced 30-day readmission rates in those patients at moderate risk for readmission.
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Keywords: AHSP = American Society of Health-System Pharmacists; AMI = Acute myocardial infarction; Centers for Medicare & Medicaid Services; DM = Diabetes mellitus; Discharge counseling; ED = Emergency department; HF = Heart failure; HTN = Hypertension; Internal medicine; MedPAC = Medicare Payment Advisory Commission; PCP = Primary care provider; PNA = Pneumonia; PPMI = Pharmacy Practice Model Initiative; Pharmacy; Readmission; Transitions of care

Document Type: Research Article

Publication date: 2013-12-01

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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