If they’re admitted to the hospital, patients with diabetes often have their blood sugar managed using different drug formulations and on a different schedule than they usually do at home. And, on release, a patient might have changes to their underlying health, or other medications related to the condition that led to their hospitalization—which can make the transition difficult.
In an effort to improve long-term outcomes for high-risk patients (including those with diabetes) after hospital release, researchers developed an intervention that would provide patients with both an inpatient pharmacist consultation prior to discharge and a direct referral to a community pharmacists. The results of the intervention, published in the Journal of the American Pharmacists Association, showed that patients who received the consultation and referral were less likely to be readmitted to the hospital within 30 days.
Hospital readmission. Source: Getty
The study was conducted with patients discharged from four Pennsylvania hospitals. Hospital pharmacists screened over 3000 patients over a two year period, and identified 618 patients that met study criteria. Of that group, 61 percent had information sent to community pharmacists. Finally, 187 patients, 150 of whom had diabetes, had consultations with their community pharmacists and were included in the final analysis. These patients had an average of around one new medication when they were discharged.
For the intervention, in-hospital pharmacists compiled a list of patient medications and a record of their care in the hospital. That information was passed via secure messaging to community pharmacists. Community pharmacists consulted with patients when they arrived to refill or pick up medications, and spoke with them via telephone if they did not have new medications. The study team provided topics for community pharmacists to discuss with patients, including reviewing medications and identifying any barriers to medication adherence. They followed up by phone up to three times, typically monthly.
Nine percent of patients in the intervention group were readmitted to the hospital within 30 days, compared with 15 percent of matched control patients who received regular pre and post discharge care. In addition, health care costs for the intervention group were lower in the 30 days post discharge. The results were similar to those from studies testing other types of transitional care programs. However, this intervention was unique in that the community pharmacists primarily operated independently, and did not require significant oversight, wrote the study authors.
The authors reported difficulties enrolling patients towards the start of the study and high dropout rates, and noted that the intervention patients were not randomized. Further research into the intervention might benefit from refinement of the study design, more attention to financial modeling, and community pharmacist supervision.
Regardless, the intervention was able to effectively reduce unnecessary readmission for patients with chronic illnesses like diabetes. “Models that improve communication between community pharmacists and inpatient care teams have the potential to positively affect transitional care for patients,” the authors wrote.