Purdue University College of Pharmacy, West Lafayette, IN.
Indiana University Health-Arnett, Lafayette, IN.
Am J Health Syst Pharm. 2020 Jun 4;77(12):931-937. doi: 10.1093/ajhp/zxaa091.
To measure the effect of a pharmacist-initiated transitions of care (TOC) program on rates of 30-day all-cause readmissions and primary care follow-up.
A retrospective cohort study was conducted to evaluate a pharmacist-initiated TOC program for patients discharged from hospitals of a large health system from September 2015 through July 2016. Discharged patients of 13 primary care physicians (the intervention cohort) received TOC program services, and discharged patients seen by 12 other primary care physicians (the control cohort) received usual care. Patients in both cohorts were followed for 90 days. The primary outcome was 30-day all-cause readmissions, and secondary outcomes were 14-day primary care visits, TOC pharmacist identification and resolution of medication therapy problems (MTPs), and transition care management (TCM) billing. Multivariable modeling was performed to test the associations of patient receipt of TOC services with 30-day readmissions and 14-day primary care visits, with controlling for patient demographics and baseline healthcare utilization.
A total of 492 patients received the TOC intervention, and 379 were followed in the usual care cohort. Among intervention patients, 960 MTPs were identified, and 85.7% of identified MTPs were resolved. Moreover, 9% of intervention cohort patients were readmitted within 30 days, compared to 15% of control cohort patients, and this effect was significant in the multivariable model (odds ratio, 1.82; 95% confidence interval, 1.15-2.89; P = 0.0108). Rates of primary care visits did not differ significantly between the groups; 65% of intervention group visits were billed using TCM codes.
A pharmacist-initiated TOC program was effective in reducing 30-day all-cause readmissions.
评估药剂师主导的过渡期护理（TOC）计划对 30 天全因再入院率和初级保健随访的影响。
本研究采用回顾性队列研究，评估了 2015 年 9 月至 2016 年 7 月期间从一家大型医疗系统出院的患者的药剂师主导的 TOC 计划。13 名初级保健医生的出院患者（干预组）接受了 TOC 计划服务，而由其他 12 名初级保健医生诊治的出院患者（对照组）接受了常规护理。两组患者均随访 90 天。主要结局是 30 天全因再入院率，次要结局是 14 天初级保健就诊、TOC 药剂师识别和解决药物治疗问题（MTP）以及过渡护理管理（TCM）计费。采用多变量模型检验患者接受 TOC 服务与 30 天再入院率和 14 天初级保健就诊的相关性，同时控制患者的人口统计学和基线医疗保健利用情况。
共有 492 名患者接受了 TOC 干预，379 名患者在常规护理组中进行了随访。在干预患者中，共发现 960 个 MTP，其中 85.7%的 MTP 得到解决。此外，干预组患者 30 天内再入院率为 9%，而对照组患者为 15%，这一差异在多变量模型中具有统计学意义（比值比，1.82；95%置信区间，1.15-2.89；P = 0.0108）。两组患者的初级保健就诊率无显著差异；干预组的 65%就诊使用了 TCM 编码计费。
药剂师主导的 TOC 计划可有效降低 30 天全因再入院率。
