Reducing readmissions in heart failure patients through pharmacist-facilitated transition-of-care interventions

Abstract

Consistent preventative pharmaceutical care interventions during care transitions with the aim of improving patient outcomes and quality care contribute to a shift towards value-based care. Value-based care may be monitored by assessing readmission rates. The aim of the study was to determine and apply pharmacist interventions during transition-of-care (TOC) to HF patients and study impact on readmission rate. The study was conducted from 20th June 2018 to 31st January, 2019, in a teaching hospital in Malta. Phase 1 of the study involved a multi-perspective focus group supported with surveys and literature to determine pharmacist interventions for a TOC pathway. Patients suffering from HF who followed the usual TOC (Phase 2) acting as the control group (N=52) were compared to the intervention group (N=27) that followed the TOC pathway (Phase 3). Recruitment involved prospective convenience sampling using eligible criteria. The proposed pathway was validated in the intervention group. The primary outcome was 30-day all-cause unplanned readmission rate. The secondary outcomes were all-cause unplanned readmission rate during the observation period from day 31-60 post-discharge and the number and type of interventions. The developed proposed pathway followed a ward-based pharmacist model with a case management approach that included medication reconciliation, medication-use education and telephone care management post-discharge. The 30-day all-cause readmission rate of the control group was 30.8% and that of the intervention group was 18.5% (p=0.242). The readmission rate between days 31-60 was 13.5% for the control group and 22.2% (p=0.211) for the intervention group. A total of 284 interventions with a mean of 10.5 per patient were performed as part of the pharmaceutical TOC pathway. The piloted TOC pathway is a quality improvement composite indicative that pharmacist interventions contributed to a reduced readmission rate of HF patients during the immediate period after discharge. Further consolidated pharmacist interventions are necessary to impact long-term readmission rate. The results obtained remain exploratory and a study on a larger population with a matched control approach is warranted.