Feldmann Joshua D, Otting Rachel I, Otting Craig M, Witry Matthew J
J Am Pharm Assoc (2003). 2018 Jan-Feb;58(1):36-43. doi: 10.1016/j.japh.2017.09.004. Epub 2017 Oct 31.
To assess the impact of a community pharmacist-delivered care transition intervention on 30-day hospital readmissions.
A single private 263-bed hospital in the Midwest United States and 12 partnering community pharmacies, 1 serving as primary pharmacy.
Adult general medicine inpatients were evaluated by nursing staff with the use of a worksheet based on the Better Outcomes by Optimizing Safe Transitions (BOOST) readmission risk toolkit. The highest-risk patients were enrolled in a 3-contact intervention. First, a pharmacist from the primary community pharmacy delivered an in-room work-up. The pharmacist focused on medication education, problem identification, and verifying medication access following discharge. A pharmacist visited the hospital for approximately 4 hours most weekdays, during which the pharmacist saw 3-4 patients. A community pharmacist telephoned these patients 8 and 25 days after discharge.
The intervention was provided to 555 patients who had a mean readmission risk worksheet score of 1.90 (SD 1.13) and not provided to 430 patients with lower readmission risk worksheet scores, which averaged 0.68 (SD 0.86; P < 0.001). Thirty-day readmissions to the study hospital were lower for intervention patients (8.1%) versus comparison patients (21.4%; P < 0.001). Thirty-day readmissions to any hospital were calculated for a subsample of 129 intervention patients and 103 comparison patients with Medicare Fee for Service insurance for which claims were available, but the difference (10.9% and 15.5%, respectively) did not reach statistical significance (P = 0.328).
A community pharmacy was successful in partnering with a hospital and other community pharmacies to lead a care transitions intervention associated with reduced 30-day same-hospital readmissions.
A community pharmacist-led intervention delivered to higher-risk patients showed a significant decrease in readmission rate to the same hospital compared with lower-risk patients hospitalized in the same unit but not receiving the intervention. This supports the community pharmacists' role in care transitions.
评估社区药剂师提供的护理过渡干预对30天内再次入院的影响。
美国中西部一家拥有263张床位的私立医院以及12家合作社区药房，其中1家作为主要药房。
成年普通内科住院患者由护理人员使用基于优化安全过渡（BOOST）再入院风险工具包的工作表进行评估。风险最高的患者被纳入一个包含3次接触的干预措施。首先，主要社区药房的一名药剂师进行病房检查。药剂师专注于药物教育、问题识别以及出院后核实药物获取情况。大多数工作日，一名药剂师会到医院约4小时，在此期间该药剂师会诊治3至4名患者。一名社区药剂师在患者出院后8天和25天给这些患者打电话。
该干预措施应用于555名患者，这些患者再入院风险工作表平均得分为1.90（标准差1.13），而未应用于430名再入院风险工作表得分较低的患者，其平均分为0.68（标准差0.86；P<0.001）。干预组患者再次入住研究医院的30天再入院率（8.1%）低于对照组患者（21.4%；P<0.001）。对129名干预组患者和103名有医疗保险服务费用报销且有相关索赔记录的对照组患者的子样本计算了30天内入住任何医院的再入院率，但差异（分别为10.9%和15.5%）未达到统计学显著性（P = 0.328）。
一家社区药房成功地与一家医院及其他社区药房合作，开展了一项与降低30天内同院再入院率相关的护理过渡干预。
与同一科室住院但未接受干预的低风险患者相比，对高风险患者实施的由社区药剂师主导的干预措施使同院再入院率显著降低。这支持了社区药剂师在护理过渡中的作用。
