Pharmacist calls to older adults with cognitive difficulties after discharge in a Tertiary Veterans Administration Medical Center: a quality improvement program.

OBJECTIVES

To evaluate the effect of the Pharmacological Intervention in Late Life (PILL) Service, which provides pharmacist telephone follow-up after discharge of older adults from the hospital, on postdischarge acute care utilization.

DESIGN

Retrospective, secondary data analysis of a quality improvement project from 2010 to 2012.

SETTING

Tertiary Veterans Affairs hospital.

PARTICIPANTS

Participants were inpatients aged 65 and older with delirium risk or prescribed a dementia medication (N=501, mean age 79.5±8.0; 98% male).

MEASUREMENTS

PILL Service pharmacist telephone follow-up included a medication review and reconciliation within 5 days after hospital discharge. The time of the pharmacist call was examined in relation to the outcomes of emergency and urgent care encounters, readmissions, and mortality within 60 days.

RESULTS

The average number of discharge medications was 14.8±5.7 with 2.8±2.2 medication changes and 1.4±1.8 discrepancies between medication order and instruction. After adjustment for age, number of medication changes, and number of discrepancies, every additional 5 minutes of pharmacist call was associated with a 15% reduction in 60-day readmission (adjusted odds ratio (OR)=0.85, 95% confidence interval (95% CI)=0.75-0.97) but was not associated with emergency or urgent care encounters (adjusted OR=1.03, 95% CI=0.91-1.17) or mortality (adjusted OR=0.84, 95% CI=0.58-1.20).

CONCLUSION

Pharmacist-led medication review, reconciliation, and telephone calls after hospital discharge were associated with fewer 60-day hospital readmissions in this quality improvement program.