Impact of a community pharmacy transitions-of-care program on 30-day readmission

Abstract

Objectives: The primary objective of this study was to evaluate the impact of a transitions-of-care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmissions.

Design, setting, and participants: A TOC program in an outpatient pharmacy, driven primarily by student pharmacists, provided telephone-based counseling to recently discharged patients. The calls were conducted within 2 to 7 days after discharge and focused on medication counseling and reconciliation, as well as promotion of a physician follow-up visit. The goal of this program was to decrease hospital readmissions among patients discharged with a cardiovascular-related diagnosis. Patient-specific information was recorded in a spreadsheet, including discharge diagnosis, and readmission diagnosis for those who returned to an inpatient facility within 30 days. This study was a retrospective chart review. Data were manually extracted from the program's data spreadsheet and the institution's electronic medical record for patients referred to the TOC program from June through November 2017. Patients discharged to hospice, prison, or a long-term care facility were excluded from analysis. Researchers collected information on patient demographics, diagnoses, and readmissions. Data analyses were performed with the use of SAS 9.4.

Outcome measures: The primary outcome measure was 30-day all-cause readmission, and the secondary measure was 30-day related readmission.

Results: A total of 1219 encounters were examined. Compared with those patients without TOC participation, those who used the TOC program had a 67% decreased odds of all-cause 30-day readmission (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.22-0.48; P < 0.0001) and a 62% decreased odds of a related readmission (OR 0.38, 95% CI 0.18-0.82; P = 0.008).

Conclusion: Community pharmacists and Advanced Pharmacy Practice Experience-level student pharmacists have the potential to make a significant impact on reducing hospital readmission rates.