Cunningham Savannah, Kinsey Joshua D
Mercer University College of Pharmacy.
Innov Pharm. 2020 Jul 31;11(3). doi: 10.24926/iip.v11i3.3352. eCollection 2020.
Pharmacists have been shown to reduce hospital readmission rates and improve adherence rates by providing discharge medication counseling and offering services such as a bedside delivery program. Hospitals are now penalized by Medicare if patients are readmitted within 30 days of discharge, so implementation of these programs have the potential to be financially significant as well. The primary endpoint of this study is to evaluate the impact of a pharmacist discharge medication counseling bedside delivery program on medication adherence rates within a six-week period following discharge. The secondary endpoint focuses on hospital readmission rates. The objective of this study is to increase collaboration between community pharmacies and hospitals in order to improve the quality of patient care. This study was designed as intervention versus control, whereas the intervention patients were those who received counseling from a pharmacist or pharmacist intern and control patients were those who did not within the same time period. Collected patient data (n=81) included patients' demographic data and all disease states, genders, and insurance coverage were encompassed by the included patients. Medication adherence was measured at follow-up intervals utilizing the proportion of days covered (PDC) equation, where a score of at least 80% is required for optimal therapeutic efficacy. Informed consent was obtained from all participants regarding a follow-up telephone call or retrieval of medication records through the pharmacy electronic medication records system and hospital electronic medical records system. Approximately 10-15-minute counseling sessions were performed at the time of discharge. Follow-up phone calls were conducted for the intervention group at four-weeks and six-weeks post-discharge to discuss medication adherence and side effects experienced. There was a total of 81 patients enrolled in this study. There were 27 patients in the intervention group and 54 patients in the control group. The pharmacist-led discharge counseling sessions made a statistically significant difference in medication adherence rates (p<0.001) as calculated using PDC, showing adherence rates of 84.4% in the intervention group and 62.8% in the control group. The pharmacist-led discharge counseling sessions made a statistically significant difference in hospital readmission rates (p=0.022), with a 24% readmission rate in the control group and a 3% readmission rate in the intervention group. Pharmacist involvement in a bedside delivery program helps to improve medication adherence in patients being discharged from a hospital. A PDC of at least 80% is required for optimal therapeutic efficacy in most classes of chronic medications, and only the intervention arm reached this threshold. The findings also show a statistically significant reduction in hospital readmission rates for patients receiving a pharmacist-led discharge counseling session.
研究表明，药剂师通过提供出院用药咨询以及开展床边送药计划等服务，能够降低医院再入院率并提高服药依从率。如果患者在出院后30天内再次入院，医院将受到医疗保险的处罚，因此实施这些计划在经济方面也可能意义重大。本研究的主要终点是评估药剂师出院用药咨询床边送药计划对出院后六周内药物依从率的影响。次要终点则关注医院再入院率。本研究的目的是加强社区药房与医院之间的合作，以提高患者护理质量。本研究设计为干预组与对照组对比，干预组患者是在同一时期内接受药剂师或药剂师实习生咨询的患者，对照组患者则是未接受咨询的患者。收集的患者数据（n = 81）包括患者的人口统计学数据，纳入的患者涵盖了所有疾病状态、性别和保险范围。利用覆盖天数比例（PDC）公式在随访间隔期测量药物依从性，最佳治疗效果要求得分至少达到80%。就后续电话随访或通过药房电子用药记录系统及医院电子病历系统获取用药记录事宜，已获得所有参与者的知情同意。出院时进行了约10 - 15分钟的咨询。对干预组在出院后四周和六周进行了随访电话，以讨论药物依从性和所经历的副作用。本研究共纳入81名患者。干预组有27名患者，对照组有54名患者。使用PDC计算得出，由药剂师主导的出院咨询在药物依从率方面有统计学显著差异（p < 0.001），干预组的依从率为84.4%，对照组为62.8%。由药剂师主导的出院咨询在医院再入院率方面有统计学显著差异（p = 0.022），对照组的再入院率为24%，干预组为3%。药剂师参与床边送药计划有助于提高出院患者的药物依从性。大多数慢性药物类别达到最佳治疗效果要求PDC至少为80%，只有干预组达到了这一阈值。研究结果还显示，接受药剂师主导出院咨询的患者，其医院再入院率在统计学上有显著降低。
