J Am Pharm Assoc (2003). 2022 May-Jun;62(3):734-739. doi: 10.1016/j.japh.2021.12.005. Epub 2021 Dec 18.
Although hospital readmission rates are declining nationally, avoidable readmissions remain a public health concern. Effective readmission interventions are multifaceted and include discharge planning and transition-of-care coordination. Clinical pharmacists are effective contributors to these processes, bringing expertise to discharge counseling, medication reconciliation, medication adherence, and postdischarge follow-up counseling.
We evaluated the impact of adding health plan clinical pharmacy management services to an existing discharge program on all-cause readmissions and postdischarge primary physician visits.
Pharmacy management services by health plan clinical pharmacists of a large regional integrated delivery system were added to an existing optimal discharge planning (ODP) program. Criteria for eligibility for these pharmacists' services included patients who prescribed a new maintenance medication after discharge, received a therapeutic substitution, had a previous discharge within 30 days, or were taking a high-risk medication. A retrospective, observational analysis of a subgroup of patients, who received the pharmacy management services as part of ODP, was performed using a difference-in-difference model, by comparing propensity-matched discharges from February 22, 2016, to January 31, 2017 (preprogram implementation) with discharges from February 22, 2017, to January 31, 2018 (implementation period), to estimate changes in 30-day readmission rates and postdischarge primary physician visits.
A total of 111 of the propensity matched received the pharmacy management services; of these, 73% (ODP) versus 64% (non-ODP) were ≥58 years, 60% were females, and 62% (ODP) versus 52% (non-ODP) were Medicare beneficiaries. There was a 16.7% (P = 0.022) statistically significant reduction in combined inpatient and observation 30-day readmissions and a 19.7% increase in 5-day postdischarge follow-up physician visits (P = 0.037) for the subgroup who also received the pharmacy management services.
Addition of pharmacist management services to an existing hospital discharge program for select at-risk patients was associated with reduced inpatient and observation 30-day readmissions.
尽管全国范围内的医院再入院率正在下降，但可避免的再入院仍是一个公共卫生关注点。有效的再入院干预措施是多方面的，包括出院计划和过渡护理协调。临床药师是这些过程的有效贡献者，为出院咨询、药物重整、药物依从性和出院后随访咨询带来专业知识。
我们评估了在现有的出院计划中增加健康计划临床药学管理服务对全因再入院和出院后主要医生就诊的影响。
大型区域综合交付系统的健康计划临床药师提供药学管理服务，加入现有的最佳出院计划（ODP）计划。这些药师服务的资格标准包括出院后开新的维持性药物、接受治疗性替代、30 天内有过出院或正在服用高危药物的患者。通过差异中的差异模型，对作为 ODP 一部分接受药学管理服务的患者亚组进行回顾性观察分析，比较 2016 年 2 月 22 日至 2017 年 1 月 31 日（项目实施前）和 2017 年 2 月 22 日至 2018 年 1 月 31 日（实施期间）的出院患者的倾向得分匹配出院，以估计 30 天内再入院率和出院后主要医生就诊率的变化。
共有 111 名符合条件的患者接受了药学管理服务；其中，73%（ODP）和 64%（非 ODP）为≥58 岁，60%为女性，62%（ODP）和 52%（非 ODP）为医疗保险受益人。在同时接受药学管理服务的亚组中，综合住院和观察 30 天内再入院率下降了 16.7%（P=0.022），5 天内出院后随访医生就诊率增加了 19.7%（P=0.037）。
为有风险的患者选择将药师管理服务加入现有的医院出院计划与降低住院和观察 30 天内再入院率有关。
