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J Gen Intern Med. 2016 May;31(5):470-7. doi: 10.1007/s11606-016-3596-3.

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial.

Author information

1
Vanderbilt Center for Translational and Clinical Cardiovascular Research (VTRACC), Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Suite 300-A 2525 West End Avenue, Nashville, TN, 37232-8300, USA. susan.p.bell@vanderbilt.edu.
2
Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN, USA. susan.p.bell@vanderbilt.edu.
3
Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
4
Center for Health Services Research, Vanderbilt University, Nashville, TN, USA.
5
Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA.
6
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
7
Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center, Nashville, TN, USA.
8
Department of Epidemiology, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
9
National Patient Safety Foundation, Boston, MA, USA.
10
Department of Pharmacy Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
11
Vanderbilt University, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.
12
Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

BACKGROUND:

Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal.

OBJECTIVE:

The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge.

DESIGN:

Randomized, controlled trial with concealed allocation and blinded outcome assessors

SETTING:

Two tertiary care academic medical centers

PARTICIPANTS:

Adults hospitalized with a diagnosis of ACS and/or ADHF.

INTERVENTION:

Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge

MAIN MEASURES:

The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported.

KEY RESULTS:

A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition.

CONCLUSION:

A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00632021.

KEYWORDS:

Acute coronary syndrome; Health literacy; Heart failure; Pharmacist; Readmissions

PMID:
26883526
PMCID:
PMC4835388
DOI:
10.1007/s11606-016-3596-3
[Indexed for MEDLINE]
Free PMC Article

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