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J Am Geriatr Soc. 2017 Jan;65(1):212-219. doi: 10.1111/jgs.14518. Epub 2016 Oct 7.

Reductions in Medication-Related Hospitalizations in Older Adults with Medication Management by Hospital and Community Pharmacists: A Quasi-Experimental Study.

Author information

1
Continuing Education and Strategic Planning, Center for Rural Health Science, Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo, Hawaii.
2
Hawaii Community Pharmacist Association, Lihue, Hawaii.
3
Maui Clinic Pharmacy, Kahului, Hawaii.
4
Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo, Hawaii.
5
Center for Elder Care and Advanced Illness, Altarum Institute, Washington, District of Columbia.
6
Blue Thorn Inc., Cary, North Carolina.
7
Kona Community Hospital, Hawaii Health Systems Corporation, Kealakekua, Hawaii.
8
Department of Clinical Education, Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo, Hawaii.
9
U.S. Public Health Service, Center for Medicare and Medicaid Innovation, Baltimore, Maryland.
10
Department of Biostatistics, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
11
Hawaii Health Information Corporation, Honolulu, Hawaii.

Abstract

OBJECTIVES:

To evaluate the association between a system of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm) and rates and costs of medication-related hospitalization in older adults.

DESIGN:

Quasi-experimental interrupted time series design comparing intervention and nonintervention hospitals using a mixed-effects analysis that modeled the intervention as a time-dependent variable.

SETTING:

Sequential implementation of Pharm2Pharm at six general nonfederal acute care hospitals in Hawaii with more than 50 beds in 2013 and 2014. All five other such hospitals served as a contemporaneous comparison group.

PARTICIPANTS:

Adult inpatients who met criteria for being at risk for medication problems (N = 2,083), 62% of whom were aged 65 or older.

INTERVENTION:

A state-wide system of medication management services provided by specially trained hospital and community pharmacists serving high-risk individuals from hospitalization through transition to home and for up to 1 year after discharge.

MEASUREMENTS:

Medication-related hospitalization rate per 1,000 admissions of individuals aged 65 and older, adjusted for case mix; estimate of costs of hospitalizations and actual costs of pharmacist services.

RESULTS:

The predicted, case mix-adjusted medication-related hospitalization rate of individuals aged 65 and older was 36.5% lower in the Pharm2Pharm hospitals after implementation than in the nonintervention hospitals (P = .01). The estimated annualized cost of avoided admissions was $6.6 million. The annual cost of the pharmacist services for all Pharm2Pharm participants was $1.8 million.

CONCLUSION:

The Pharm2Pharm model was associated with an estimated 36% reduction in the medication-related hospitalization rate for older adults and a 2.6:1 return on investment, highlighting the value of pharmacists as drug therapy experts in geriatric care.

KEYWORDS:

cost avoidance; geriatric care model; medication management; medication-related hospitalization; pharmacist

PMID:
27714762
DOI:
10.1111/jgs.14518
[Indexed for MEDLINE]

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