Can a pharmacist-led intervention reduce hospital readmissions and emergency department visits?

An extensive intervention by hospital pharmacists—including multiple medication reviews, motivational interviews with patients, communication with primary care physicians, and follow-up phone calls after discharge—led to a reduction in short-term and long-term readmission rates. The cost effectiveness of such an intervention has not yet been determined. (LOE = 1b)

Ravn-Nielsen LV, Duckert M, Lund ML, et al. Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission. JAMA Intern Med 2018 Jan 29. doi: 10.1001/jamainternmed.2017.8274. [Epub ahead of print]  [PMID:29379953]

Randomized controlled trial (nonblinded)

Foundation

Concealed

Inpatient (any location) with outpatient follow-up

In this study from Denmark, investigators randomized 1467 hospitalized patients who were taking 5 or more prescription medications to receive usual care, a basic pharmaceutical intervention, or an extended pharmaceutical intervention. The basic intervention group received a medication review by a clinical pharmacist shortly following admission to the hospital with recommendations made by the pharmacist to the hospital physician regarding potential medication changes. The extended intervention group received the same medication review upon admission, but also received the following: (1) medication reconciliation discussion between the pharmacist and the patient prior to discharge using a motivational interview approach; (2) a summary note encompassing changes in medications sent to the primary care physician; (3) phone calls by the pharmacist to the primary care physician, caregiver, and primary pharmacist after discharge if medications were changed during hospitalization; and (4) follow-up phone calls by the pharmacist to the patient 1 week and 6 months after discharge to discuss medications, again using the motivational interview approach. All pharmacists involved in the intervention received training in medication review and motivational interview techniques. The average time spent on the basic and extended interventions was 26 minutes and 114 minutes, respectively. The primary outcome of the composite of 30-day and 180-day readmission rates and emergency department visits within 180 days was decreased in the extended intervention group as compared with the usual care group (hazard ratio 0.77; 95% CI 0.64 - 0.93). When looking at individual outcomes, readmission rates were reduced both at 30 days and 180 days but there was no significant difference detected in the rate of emergency department visits between the extended intervention and usual care groups. In addition, drug-related readmissions or deaths were not different between the 2 groups. No significant differences were noted in any outcomes comparing the basic intervention to usual care, suggesting that a medication review alone is not sufficient to reduce the number of emergency department visits and readmissions.