Impact of ambulatory care pharmacist intervention on 30-day readmission rates in high-risk transitions-of-care patients.

BACKGROUND: Care transitions are a challenging and crucial point for many high-risk patients; errors in medication use can result in preventable hospital readmissions, which worsen patient outcomes and result in decreased reimbursement and increased expenses for health systems. Transitions of care (TOC) is an opportunity where pharmacists in the outpatient setting can prevent medication errors and decrease hospital readmissions. OBJECTIVE: The primary objective of this study was to evaluate the impact of pharmacist-conducted comprehensive medication reviews (CMRs) on 30-day hospital readmission rates. Secondary objectives included medication therapy problems (MTPs) identified, recommendations or interventions made, and impact on cost savings. METHODS: Patients discharged from an Intermountain Health hospital with a high readmission risk score, value-based insurance plan, and primary care provider (PCP) at one of 21 primary care clinics were identified using an internal report. Patients were contacted by a pharmacist after discharge for a CMR; pharmacists then relayed any MTPs and therapeutic recommendations to the PCP before the patient's follow-up appointment. Data were retrospectively collected and analyzed. RESULTS: A total of 2717 discharges occurred throughout Intermountain Health and affiliate clinics from October 5, 2020, to January 31, 2021; 30-day readmissions rates in the pharmacist intervention group versus the comparator group were 24/191 (12.57%) versus 511/2526, (20.23%), respectively, yielding a statistically significant difference (P < 0.05). The absolute risk of readmission was reduced by 7.66%, with a number needed to treat of 14. Approximately 14 readmissions were prevented in the pharmacist intervention group, resulting in an estimated cost savings of $212,800 and return on investment of $16.19:1. CONCLUSION: Pharmacist intervention in the outpatient setting in high-risk TOC patients resulted in decreased 30-day readmission rates and increased cost savings. Further investigation is warranted to identify patient factors where pharmacist intervention is most beneficial.

Population health model for pharmacist assessment and independent prescribing of statins in an ambulatory care setting.

OBJECTIVE: This study aimed to evaluate the impact of a pharmacist population health initiative on the ability to increase the percentage of patients with atherosclerotic cardiovascular disease (ASCVD) who are on an appropriate statin. SETTING: Ten primary care clinics in Southwest Washington. The average payer mix across the included clinics is 47% Medicare, 26% commercial, 22% Medicaid, 2% self-pay, and 3% other. Reimbursement-tied statin quality metrics are present in 14.1% of patients' insurance contracts. PRACTICE DESCRIPTION: The primary care pharmacy collaborative drug therapy agreement allows pharmacists to act as prescribers by permitting initiation, adjustment, and monitoring of medication therapy, with the authority historically stemming from referral by the patient's primary care provider to the pharmacist. PRACTICE INNOVATION: A novel, population health protocolized prescriptive authority (PPA) initiative was implemented, of which a key component was expanding pharmacists' prescriptive authority to prescribe statins for population health initiatives. Without referral, pharmacists screened, directly outreached to, and prescribed statins for patients with ASCVD who were not on a moderate- or high-intensity statin. Electronic health record (EHR) documentation was updated to better reflect the patient's history and increase metric accuracy. EVALUATION: A retrospective analysis of a population health initiative from October 1 to December 31, 2018. The initiative was evaluated on the combined success of initiating patients with ASCVD on moderate- or high-intensity statins and the acceptance rate of EHR corrections. RESULTS: The pharmacy team screened 510 patients. Appropriately dosed statins were initiated for 40.0% of patients, and the EHR was accurately updated in 91.9% of instances. These combined efforts demonstrate 50.5% overall success of pharmacist interventions. CONCLUSION: Expanding pharmacists' authority to PPA for statin medications in patients not meeting quality metrics increased the number of successful interventions. Pharmacists make a major contribution on improving population health metrics for statins.