Weiyi Ni, Danielle Colayco, Jonathan Hashimoto, Kevin Komoto, Chandrakala Gowda, Bruce Wearda, and Jeffrey McCombs analyzed the results of a program tested at Kern Health Systems in Bakersfield which allowed pharmacists with Synergy Pharmacy Solutions to oversee the transition of about 1,100 high-risk Medicaid patients discharged the hospital between April 2013 and March 2015. McCombs and his colleagues found pharmacists given an expanded role in patient oversight can reduce the likelihood of high-risk patients returning to the hospital.
According to the study, the Synergy pharmacists’ transition of care program reduced the 30-day readmission rates for the Kern Health Systems by as much as 28 percent. It also reduced patients’ 180-day readmission rates by nearly 32 percent. The study was conducted in partnership with the Komoto Foundation, Synergy Pharmacy Solutions and Kern Health Systems.
In the first 30 days of discharge, the Synergy pharmacists counseled the patients to make sure they took their medications as prescribed, followed up with post-discharge appointments, assisted the patients who needed a specialist, and arranged for transportation to take them to and from their appointments. They also worked with each patient’s pharmacy to address any problems or questions that arose regarding their insurance benefits.
The patients identified as high-risk at Kern Health Systems had a history of high medical needs, were discharged with five or more prescriptions and had been admitted to a hospital within the last 45 days. Most patients in the study were age 45 and older.
For the 30-day discharge period, researchers tracked the progress of 830 patients who were high risk and received the additional pharmacist care. They compared those patients to a control group of 1,005 patients who were not high risk and who had been discharged from neighboring hospitals.
Patients with the greatest risk of readmission 30 days after discharge were those with heart disease, chronic obstructive pulmonary disease (COPD), potentially cancerous tissues (neoplasms), digestive diseases and infectious or parasitic diseases. Also at risk were patients who had prescriptions for anti-epileptic drugs, dialysis solutions and dietary supplements.
The patients facing the greatest risk of readmission six months after discharge included those who had been hospitalized before, had COPD, infections, parasitic diseases, diabetes or blood disorders. Patients who were taking dialysis solutions or dietary supplements such as intravenous nutrition were also at greater risk, the researchers wrote.
For the 180-day post-discharge portion of the study, researchers focused on 558 of the patients in the high-risk study group to determine whether the pharmacist intervention would have a longer term effect.
After applying an alternative statistical method to adjust for demographics and clinical issues, researchers found that patients in the transition of care program at Kern Family Health Care had a 25 percent lower risk of hospital readmission compared with patients receiving usual care, the study found.
The full study is available at AJMC. The press release about the study is available here.
Citation: Gowda, C., Wearda, B., & McCombs, J. (2017). Impact of a pharmacy-based transitional care program on hospital readmissions. AMERICAN JOURNAL OF MANAGED CARE, 23(3), 170-176.