An article in the American Journal of Managed Care reports on a program tested at Kern Health Systems in Bakersfield, California. Pharmacists with Synergy Pharmacy Solutions were empowered to oversee the transition of about 1,100 high-risk Medicaid patients discharged from the hospital from April 2013 through March 2015.
“This is the latest study to show that expanding the scope of practice for pharmacists could help patients and still save the health system money,” explained corresponding author Jeffrey McCombs, PhD, an associate professor at USC School of Pharmacy and researcher at the USC Schaeffer Center for Health Policy and Economics. “The evidence is clear that community-based pharmacists can reduce health costs. The question is: Who will pay for expanding their role beyond dispensing medications at the counter?”
Results of the study indicate that the transition of care program dropped the 30-day readmission rates for Kern Health Systems by as much as 28%, while also reducing patients’ 180-day readmission rates by nearly 32%, compared to a control group of 1,005 patients who were not high risk and who had been discharged from neighboring hospitals.
In the first month after discharge, pharmacists counseled patients to make sure they took their medications as prescribed, followed up with postdischarge appointments, were able to see necessary specialists, and had transportation to take them to and from their appointments. At the same time, the Synergy pharmacists worked closely with each patient’s regular pharmacy to avoid any problems with insurance benefits.
Patients involved in the program had a history of high medical needs, were discharged with five or more prescriptions, and had been admitted to a hospital within the last 45 days. Most patients in the study were aged ≥45 years.
Patients with the greatest risk of readmission 30 days after discharge were those with heart disease, chronic obstructive pulmonary disease (COPD), potentially cancerous tissues (neoplasms), digestive diseases, and infectious or parasitic diseases. Also at risk were patients who had prescriptions for antiepileptic drugs, dialysis solutions, and dietary supplements.
The study found that patients facing the greatest risk of readmission 6 months after discharge included those who had been hospitalized before, had COPD, infections, parasitic diseases, diabetes, or blood disorders. Also at higher risk of readmission were patients who were taking dialysis solutions or dietary supplements such as intravenous nutrition.
For the 180-day postdischarge portion of the study, researchers focused on 558 of the patients in the high-risk study group to determine whether the pharmacist intervention would have a longer-term effect and found that cohort had a 25% lower risk of hospital readmission compared with patients receiving usual care.
Study authors note that, by 2025, the shortfall of primary-care physicians in the United States could range from 14,900 to as many as 35,600.
