Implementation of a Cardiac Transitions of Care Pilot Program: A Prospective Study of Inpatient and Outpatient Clinical Pharmacy Services for Patients With Heart Failure Exacerbation or Acute Myocardial Infarction

Abstract

Background:

Pharmacists may assist with reducing 30-day readmission rates for patients with heart failure (HF) exacerbation or acute myocardial infarction (AMI) by promoting medication adherence.

Objective:

To determine the change in 30-day readmission rates for patients with HF exacerbation or AMI after implementation of a “high-touch” standard of care.

Methods:

Patients admitted with HF exacerbation, non-ST-segment elevation AMI, or ST-segment elevation AMI from August 1, 2013, to June 30, 2015, were included in this prospective study. Patients were educated while in the inpatient setting and followed up in the outpatient setting through telephone contact and scheduling a medication therapy management (MTM) appointment with a pharmacist. Data were collected by pharmacy personnel involved in the implementation of the intervention.

Results:

Within the HF and AMI arms, 100 and 93 patients, respectively, were included in the study. The 30-day readmission rates were 24% and 17.2% for HF and AMI, respectively, which were not statistically significant when compared to historical institutional readmission rates prior to study initiation (18.2% for HF, P = .238; 11.4% for AMI, P = .252).

Conclusion:

A “high-touch” pharmacist-driven transitions of care program may affect 30-day readmission rates for patients with HF exacerbation or AMI; potential processes for initiating transitions of care programs are provided.

Keywords

transitions of care cardiology medication therapy management readmission patient education

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References

Readmissions-Reduction-Program [Internet]. CMS.gov Centers for Medicare & Medicaid Services. Centers for Medicare and Medicaid Services. 2016. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed November 12, 2017.

Jencks

Williams

Coleman

. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–1428.

Quality and Patient Safety [Internet]. Agency for Healthcare Research and Quality: Advancing Excellence in Health Care. US HHS: Agency for Healthcare Research and Quality. 2013. http://www.ahrq.gov/qual/hospsurveydb/. Accessed November 12, 2017.

Improving Transitions of Care: Findings and Considerations of the “Vision of the National Transitions of Care Coalition”

[Internet]. National Transitions of Care Coalition. 2010. http://www.ntocc.org/portals/0/pdf/resources/ntoccissuebriefs.pdf. Accessed November 12, 2017.

Transitions of care: the need for a more effective approach to continuing patient care

[Internet]. The Joint Commission. 2012. https://www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf. Accessed November 12, 2017.

Harrison

Browne

Roberts

, et al. Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition. Med Care. 2002;40(4):271–282.

Jack

Chetty

Anthony

, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150(3):178–187.

Educating patients before they leave the hospital reduces readmissions, emergency department visits and saves money

[Internet]. Agency for Healthcare Research and Quality. 2009. https://archive.ahrq.gov/news/newsletters/e-newsletter/270.html. Accessed November 12, 2017.

Kociol

Peterson

Hammill

, et al. National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry. Circ Heart Fail. 2012;5(6):680–687.

10.

Clark

Nadash

. The effectiveness of a nurse-let transitional care model for patients with congestive heart failure. Home Healthc Nurse. 2004;22(3):160–162.

11.

Szkiladz

Carey

Ackerbauer

, et al. Impact of pharmacy student and resident-led discharge counseling on heart failure patients. J Pharm Pract. 2013;26(6):574–579.

12.

McNeely

. Treatment considerations and the role of the clinical pharmacist throughout transitions of care for patients with acute heart failure. J Pharm Pract. 2017;30(4):441–450.

13.

Balling

Erstad

Weibel

. Impact of a transition-of-care pharmacist during hospital discharge. J Am Pharm Assoc (2003). 2015;55(4):443–448.

14.

Kalista

Lemay

Cohen

. Postdischarge community pharmacist-provided home services for patients after hospitalization for heart failure. J Am Pharm Assoc (2003). 2015;55(4):438–442.

15.

Gunadi

Upfield

Pham

, et al. Development of a collaborative transitions-of-care program for heart failure patients. Am J Health System Pharm. 2015;72(13):1147–1152.

16.

Erickson

AK.

Targeting transitions: pharmacists critical to reducing readmissions

[Internet]. American Pharmacists Association. 2013. https://www.pharmacist.com/targeting-transitions-pharmacists-critical-reducing-readmissions. Accessed November 12, 2017.

17.

Luder

Frede

Kirby

, et al. TransitionRx: impact of community pharmacy postdischarge medication therapy management on hospital readmission rate. J Am Pharm Assoc (2003). 2015;55(3):246–254.

18.

Oliveira

Brummel

Miller

. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010;16(3):185–195.

19.

Your guide to lowering your blood pressure with DASH

[Internet]. US Department of Health and Human Services. 2006. https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf. Accessed November 12, 2017.

20.

Budiman

Snodgrass

Komatsu Chang

. Evaluation of pharmacist medication education and post-discharge follow-up in reducing readmissions in patients with ST-segment elevation myocardial infarction (STEMI). Ann Pharmacother. 2016;50(2):118–124.

21.

Implementation of a medication therapy management intervention in ambulatory care settings: experiences and lessons learned from the MyRx pilot

[Internet]. Agency for Healthcare Research and Quality. 2016. https://innovations.ahrq.gov/sites/default/files/experiences_and_lessons_learned_from_the_myrx_pilot.pdf. Accessed November 12, 2017.

22.

Melody

McCartney

Sen

, et al. Optimizing care transitions: the role of the community pharmacist. Integr Pharm Res Pract. 2016;5:43–51.

23.

Sen

Bowen

Ganetsky

, et al. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings. Pharm Pract (Granada). 2014;12(3):439.

24.

Martin

Williams

Haskard

, et al. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(3):189–199.