Impact of ambulatory care pharmacist intervention on 30-day readmission rates in high-risk transitions-of-care patients.

Background: Care transitions are a challenging and crucial point for many high-risk patients; errors in medication use can result in preventable hospital readmissions, which worsen patient outcomes and result in decreased reimbursement and increased expenses for health systems. Transitions of care (TOC) is an opportunity where pharmacists in the outpatient setting can prevent medication errors and decrease hospital readmissions.

Objective: The primary objective of this study was to evaluate the impact of pharmacist-conducted comprehensive medication reviews (CMRs) on 30-day hospital readmission rates. Secondary objectives included medication therapy problems (MTPs) identified, recommendations or interventions made, and impact on cost savings.

Methods: Patients discharged from an Intermountain Health hospital with a high readmission risk score, value-based insurance plan, and primary care provider (PCP) at one of 21 primary care clinics were identified using an internal report. Patients were contacted by a pharmacist after discharge for a CMR; pharmacists then relayed any MTPs and therapeutic recommendations to the PCP before the patient's follow-up appointment. Data were retrospectively collected and analyzed.

Results: A total of 2717 discharges occurred throughout Intermountain Health and affiliate clinics from October 5, 2020, to January 31, 2021; 30-day readmissions rates in the pharmacist intervention group versus the comparator group were 24/191 (12.57%) versus 511/2526, (20.23%), respectively, yielding a statistically significant difference (P < 0.05). The absolute risk of readmission was reduced by 7.66%, with a number needed to treat of 14. Approximately 14 readmissions were prevented in the pharmacist intervention group, resulting in an estimated cost savings of $212,800 and return on investment of $16.19:1.

Conclusion: Pharmacist intervention in the outpatient setting in high-risk TOC patients resulted in decreased 30-day readmission rates and increased cost savings. Further investigation is warranted to identify patient factors where pharmacist intervention is most beneficial.