In part three of this series we look at the role pharmacists can play in reducing avoidable readmissions.
The clinical process of care and patient experience–both of which have pharmaceutical implications–make up 45 percent and 30 percent of hospitals’ performance scores (HCAHPS), respectively. Enlisting the pharmacist’s expertise both during and after a patient’s stay can have a positive impact on both and reduce readmissions, thereby decreasing fines and increasing reimbursement from Medicare while improving patients’ long-term health.
In an effort to mitigate financial implications of readmissions, hospitals have begun to involve pharmacists in their patients’ continuum of care. The results have been promising as pharmacy-based transition of care interventions that include medication therapy management (MTM) services–which begin in-facility and don’t end until after a patient is discharged–have been shown to reduce hospital readmissions.
The hospital pharmacy department can help ensure patients get their prescriptions filled, ease confusion about what medicines to take and when, and prevent adverse drug events.
One facility, Barnes-Jewish Hospital, found that readmissions largely stemmed from almost half of discharged patients failing to fill their prescriptions. They have since addressed that issue by giving hospital patients the ability to fill prescriptions at their bedside. Not only can patients walk out of the hospital with their medications in hand, but they can speak with pharmacists during their stay and become comfortable with their drug regimen.
Speaking directly with patients enables the pharmacists to discuss possible side effects, which may lead to patients discontinuing a medication or taking less of it. It also gives pharmacists the opportunity to go over the regimen to ensure there are no drug interactions or duplicate medication therapies.
Pharmacists can also direct patients who are on multiple medications to a pharmacy near them that offers medication adherence packaging. Patients can have their medications arranged in blister packs with specific instructions and illustrations to combat confusion and increase adherence.
With a coordinated hospital discharge system, pharmacists can help reduce readmissions by offering medication reconciliation and education.
The pharmacy team at Mercy Hospital & Medical Center in Chicago worked collaboratively with their affiliate, Mercy Family Health Center, to develop a multidisciplinary discharge clinic housed at the Health Center. Patients were scheduled for 30-minute follow-up visits with a pharmacist and nurse practitioner where the pharmacist conducted a comprehensive medication history and hospital course evaluation. The discharge clinic saw readmission rates for all its patients, many of which were high-risk, decrease from 7 percent in its first quarter to 1 percent a year later.
A study published in the most recent edition of the Journal of the American Pharmacists Association found that patients who received a full range of MTM services from a pharmacist within one week of discharge experienced significantly fewer readmissions than those who received usual care. Of the 90 patients who completed the study, only 6.9% of those who received MTM services from a pharmacist were readmitted within 30 days compared to 20% of patients who received usual care.
Also gaining popularity in the fight to reduce preventable readmissions are free home visits by a pharmacist, especially for frail elderly patients with serious, chronic illnesses, who take multiple medications and are unable to leave their homes.
For such patients leaving Regions Hospital in St. Paul, Minnesota, having a home visit by a pharmacist within a week after discharge has decreased readmissions within 30 days to 6%, vs 16% for those who chose not to have a home visit. During these visits, the pharmacist reviews medications, helps the patient understand how to take medications as prescribed, and evaluates whether there are any safety risks in the home.
Pharmacists play a key role in preventing some types of readmissions. By visiting with patients both during and after their hospital stay they can impart greater levels of understanding to patients about their medications and better recognition of symptoms associated with their diseases. They can also identify common medication problems such as:
- Medication no longer being needed
- Medication not being taken as prescribed
- New medication being needed
- Medication dose being incorrect
As more hospitals recognize and take advantage of the value that a pharmacist brings to the table, preventable readmission rates will continue to decrease.