A community pharmacist-led service to facilitate care transitions and reduce hospital readmissions

Objectives: To assess the impact of a community pharmacist-delivered care transition intervention on 30-day hospital readmissions. Setting: A single private 263-bed hospital in the Midwest United States and 12 partnering community pharmacies, 1 serving as primary pharmacy. Practice innovation: Adult general medicine inpatients were evaluated by nursing staff with the use of a worksheet based on the Better Outcomes by Optimizing Safe Transitions (BOOST) readmission risk toolkit. The highest-risk patients were enrolled in a 3-contact intervention. First, a pharmacist from the primary community pharmacy delivered an in-room work-up. The pharmacist focused on medication education, problem identification, and verifying medication access following discharge. A pharmacist visited the hospital for approximately 4 hours most weekdays, during which the pharmacist saw 3-4 patients. A community pharmacist telephoned these patients 8 and 25 days after discharge. Evaluation: The intervention was provided to 555 patients who had a mean readmission risk worksheet score of 1.90 (SD 1.13) and not provided to 430 patients with lower readmission risk worksheet scores, which averaged 0.68 (SD 0.86; P < 0.001). Thirty-day readmissions to the study hospital were lower for intervention patients (8.1%) versus comparison patients (21.4%; P < 0.001). Thirty-day readmissions to any hospital were calculated for a subsample of 129 intervention patients and 103 comparison patients with Medicare Fee for Service insurance for which claims were available, but the difference (10.9% and 15.5%, respectively) did not reach statistical significance (P = 0.328). Practice implication: A community pharmacy was successful in partnering with a hospital and other community pharmacies to lead a care transitions intervention associated with reduced 30-day same-hospital readmissions. Conclusion: A community pharmacist-led intervention delivered to higher-risk patients showed a significant decrease in readmission rate to the same hospital compared with lower-risk patients hospitalized in the same unit but not receiving the intervention. This supports the community pharmacists' role in care transitions. (C) 2018 American Pharmacists Association (R). Published by Elsevier Inc.