Evaluation of the impact of a pharmacy transitions of care program.

PURPOSE: Pharmacist-driven transitions of care interventions have been shown to improve patient clinical outcomes. However, the evidence in the literature on the impact of pharmacy transitions of care services on hospitalization and emergency department visit rates is inconclusive. The purpose of this study is to determine the impact of a pharmacist-driven transitions of care program on hospitalization and emergency department visit rates at an academic medical center. METHODS: This retrospective observational cohort study was conducted via pre- and postintervention analyses. The data collection period included 30 days before the date of pharmacist intervention and 30 days after the date of intervention. The study evaluated patients who were enrolled in the Transitional Inpatient Rounding Experience (TIRE) program at Wake Forest Baptist Health between August 2017 and September 2020. Patients excluded were less than 18 years old, in hospice care, discharged to long-term care, or did not have a hospitalization within 90 days of intervention. The Wilcoxon signed rank test was utilized to analyze continuous data. Standard descriptive statistics were used for categorical data. RESULTS: One hundred patients met the inclusion criteria for this study. For the primary outcome, the TIRE intervention resulted in a reduction of 31 hospitalizations, or 50% (62 prior hospitalizations in the 30 days before the intervention vs 31 admissions in the 30 days after the intervention; P < 0.001). There were significant reductions in the secondary outcomes of 90-day hospitalizations (24% fewer with intervention; P = 0.028) and 30-day emergency department visits (65% fewer with intervention; P =0.006). For the outcome of 90-day emergency department visits, there was a 36% reduction (P = 0.240). CONCLUSION: The results of the study demonstrate that a pharmacy transitions of care program may lead to a reduction in hospitalization and emergency department visit rates. The study also found potential cost savings associated with a pharmacy transitions of care program.

Development of a screening tool to identify patients likely to benefit from clinical pharmacist review in a home-based primary care population.

OBJECTIVE: To create a novel screening tool that identified patients who were most likely to benefit from pharmacist in-home medication reviews. DESIGN: Single-center, retrospective study. SETTING AND PARTICIPANTS: A total of 25 homebound patients in Forsyth County, NC, aged 60 years or older with physical or cognitive impairments and enrolled in home-based primary care or transitional and supportive care programs participated in the study. Pharmacy resident-provider pairs conducted home visits for all patients in the study. Pharmacy residents assessed the subjective risk (high, medium, low) of medication nonadherence using information obtained from home visits (health literacy, support network, medications, and detection of something unexpected related to medications). An electronic medical record-based risk score was simultaneously calculated using screening tool components (i.e., electronic frailty index score, LACE+ index [length of stay in the hospital, acuity of admission, comorbidity, emergency department utilization in the 6 months before admission], and 2015 American Geriatric Society Beers Criteria). OUTCOME MEASURES: The electronic medical record-based screening tool numerical risk scores were compared with pharmacy resident subjective risk assessments using tree-based classification models to determine screening tool components that best predicted pharmacy residents' subjective assessment of patients' likelihood of benefit from in-home pharmacist medication review. Following the study, satisfaction surveys were given to providers and pharmacy residents. RESULTS: The best predictor of high-risk patients was an electronic frailty index score greater than 0.32 (indicating very frail) or LACE+ index greater than or equal to 59 (at high risk for hospital readmission). Pharmacy residents and providers agreed that homebound patients at high-risk for medication noncompliance benefited from pharmacist time and attention in home visits. CONCLUSION: In homebound older persons, this screening tool allowed for the identification of patients at high-risk for medication nonadherence through targeted in-home pharmacist medication reviews. Further studies are needed to validate the accuracy of this tool internally and externally.