RESUMEN
This study is a qualitative case series of lifestyle medicine practitioners' protocols for medication de-escalation in the context of reduced need for glucose-lowering medications due to lifestyle modifications. Increasing numbers of lifestyle medicine practitioners report achieving reductions in medications among patients with type 2 diabetes, and in some cases remission, but limited data exist on the clinical decision-making process used to determine when and how medications are deprescribed. Practitioners interviewed here provide accounts of their deprescribing protocols. This information can serve as pilot data for other practitioners seeking examples of how deprescribing in the context of lifestyle medicine treatment is conducted.
RESUMEN
OBJECTIVE: The Medicare Hospital Readmissions Reduction Program (MHRRP) which took effect on October 1st, 2012 holds providers accountable for quality of care delivered, placing a greater focus on care coordination. Innovative strategies in medication management in the acute care and outpatient primary care settings require vigilant pharmacist intervention. The objective of this study is to determine if pharmacist-provided medication reconciliation service in conjunction with hospital follow-up outpatient physician visits reduces hospital readmission rate. METHODS: This was a prospective study in which physician-initiated outpatient hospital follow-up appointment scheduling was used to identify patients at time of hospital discharge. All patients ≥50 years of age were eligible for outpatient pharmacist visits. Emergency room visits were excluded. Data collected included: patient demographics, characteristics of identified drug therapy problems, accuracy of outpatient medication histories and time required by pharmacist to perform the reviews. Patient adherence to early (24-72 hours) outpatient hospital follow-up visit was also evaluated. Previous year's readmission data for high risk patients who received only physician visits were also collected for comparison with those who were jointly visited by pharmacists and physicians. RESULTS: A total of 98 patients were assigned to receive pharmacist intervention in conjunction with physician hospital follow-up visits. Nine of the 98 patients seen by pharmacists at hospital follow-up visits were readmitted (9.2%) to a hospital within 30 days of discharge. Out of the 236 patients seen during the same period the previous year (2011) for physician alone hospital follow-up visits 46 were readmitted (19.4%) within 30-days of hospital discharge. The difference between these groups was statistically significant (p = 0.023), with patients in the pharmacist intervention group experiencing a reduction in 30-day readmission risk. Physician alone outpatient follow-up was associated with earlier mean time to readmission, 12.8 days vs. 18.3 days in the pharmacist intervention group (p = 0.042). CONCLUSION: Pharmacist involvement in hospital discharge follow-up visits reduced overall readmission rate in high risk patients and improved monitoring of drug therapy, and medication history accuracy when compared to physician-alone visits.