Polinski Jennifer M, Moore Janice M, Kyrychenko Pavlo, Gagnon Michael, Matlin Olga S, Fredell Joshua W, Brennan Troyen A, Shrank William H
Jennifer M. Polinski (
Janice M. Moore is a senior adviser at CVS Health in Northbrook, Illinois.
Health Aff (Millwood). 2016 Jul 1;35(7):1222-9. doi: 10.1377/hlthaff.2015.0648.
Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care.
药物不良事件以及明确和遵循复杂药物治疗方案所面临的挑战是导致患者再次入院的主要因素。药物重整计划可以降低出院后药物不良事件的发生率,但关于药物重整对再入院率和医疗保健成本影响的证据尚不清楚。我们研究了一项由保险公司发起的护理过渡计划,该计划基于药剂师通过家访和电话进行的药物重整,并探讨了其对高危患者的影响。我们考察了自愿参与该计划是否与药物使用改善、再入院率降低以及扣除计划成本后的节省有关。计划参与者在出院后30天内再次入院的相对风险降低了50%,绝对风险降低了11.1%。该计划每花费1美元可节省2美元。这些结果表明,由保险公司发起、药剂师主导的护理过渡计划,专注于但不限于药物重整,有可能改善临床结局并降低护理总成本,这是来自现实世界的证据。