J Am Pharm Assoc (2003). 2021 May-Jun;61(3):276-283.e1. doi: 10.1016/j.japh.2021.01.009. Epub 2021 Jan 31.
Pharmacists' involvement in the transitions of care has shown the potential to decrease readmissions and increase access to care in many populations; however, the uninsured patient populations have not been studied. The evidence for the feasibility of implementing transitions of care services in indigent care clinics with limited resources also remains limited. The objectives were to implement a pharmacist-led transitions of care program in an indigent care clinic, to demonstrate the feasibility of its implementation, and to evaluate its impact on readmissions and emergency department (ED) visit rates among an uninsured population.
The study was a single-blind, parallel, randomized controlled trial implemented in an indigent care clinic in the Southeast region of the United States from October 2018 to July 2019. Eligible patients were those older than 18 years, uninsured, English-speaking, diagnosed with any condition, and recently discharged from a local community hospital within the past 16 days. The primary outcome was the hospital readmission rate at 30 days after discharge. The secondary outcomes included 60- and 90-day readmission rates in addition to 30-, 60-, and 90-day ED visit rates.
A total of 88 participants were recruited. The intervention was successfully implemented in the clinic, but patient-level barriers to follow-ups included transportation, accessibility, financial burdens, inconsistent telephone communication, and a lack of knowledge about the importance of follow-ups. At 30 days postdischarge, 13.64% of the patients in the usual care group experienced readmissions compared with 9.30% of the patients in the intervention group. The relative change in the 30-day readmission rates between the usual care and the intervention groups was 1.7 (rate ratio [RR] 1.69 [95% CI 0.47-6.08]). The RRs were insignificant for the 30-, 60-, and 90-day readmission and ED visit rates.
This study demonstrated the feasibility of implementing transitions of care services in a clinic with limited resources by pharmacists. The intervention showed promising results by reducing readmission rates.
药师参与过渡期护理已显示出在许多人群中降低再入院率和增加护理可及性的潜力；然而，尚未对未参保患者人群进行研究。在资源有限的贫困者护理诊所中实施过渡期护理服务的可行性的证据仍然有限。本研究旨在实施一个由药师主导的过渡期护理计划，并在一个贫困者护理诊所中证明其实施的可行性，同时评估其对一个未参保人群的再入院率和急诊部（ED）就诊率的影响。
该研究是在美国东南部的一个贫困者护理诊所中进行的一项单盲、平行、随机对照试验，于 2018 年 10 月至 2019 年 7 月进行。合格患者为年龄大于 18 岁、无保险、英语流利、诊断出任何疾病且在过去 16 天内最近从当地社区医院出院的患者。主要结局为出院后 30 天的再入院率。次要结局包括 60 天和 90 天的再入院率以及 30 天、60 天和 90 天的 ED 就诊率。
共招募了 88 名参与者。该干预措施在诊所中成功实施，但患者层面的随访障碍包括交通、可达性、经济负担、电话沟通不一致以及缺乏对随访重要性的认识。在出院后 30 天，常规护理组有 13.64%的患者经历再入院，而干预组有 9.30%的患者经历再入院。常规护理组和干预组之间 30 天再入院率的相对变化为 1.7（率比[RR]1.69[95%CI0.47-6.08]）。30 天、60 天和 90 天的再入院率和 ED 就诊率的 RR 均无统计学意义。
本研究证明了在资源有限的诊所中由药师实施过渡期护理服务的可行性。该干预措施通过降低再入院率显示出了有前景的结果。
