Category: Professional Posters
Purpose: Reduction of hospital readmission rates are a focus for hospitals to improve quality of care and optimize reimbursement. Hospital based outpatient pharmacies can provide assistance through eliminating barriers to accessing medications and provide drug counseling. Patients with co-payments of $50 were four times more likely to abandon a prescription than patients paying $10. Up to 50 percent of prescriptions never reach a pharmacy. The primary goal of this project was to provide access to medications to positively improve outcomes and reduce readmission rates. A secondary goal was to ensure patients understand the importance of their medications and possible side effects.
Methods: A transitions of care team housed within a community hospital outpatient pharmacy was developed. The project team developed a platform within their electronic medical record to identify patients who are at high risk for readmission, focused on high cost medications which often require prior authorizations and patients who are uninsured or under-insured. The team then worked with case management and nursing to assist with enrollment into the bedside delivery program. Case management involvement was essential with assisting with patients who face economic hardship when trying to maintain a medication regimen. The transitions of care team review medication profiles to identify drug-drug interactions, duplicate therapies, and high cost medications before the patients are discharged. The transitions of care team proactively reach out to the clinical team when an issue is identified allowing corrections to be made prior to discharge. Prescriptions are filled and delivered to the patients' bedside before discharge. Prescription counseling by a pharmacist is provided to all patients who participate in the bedside program to ensure comprehension of how to properly use their medications and understand possible side effects. The transitions of care team identify and resolve payment barriers to purchasing prescriptions. An analysis of readmission rates were performed and comparisons were made between patients who received medications at discharge to patients who chose not to participate in the bedside delivery program.
Results: This project has resulted in an increase from a 5 percent discharge prescription capture rate, to 61 percent (12.2 fold increase) of all discharge prescriptions being filled by the hospital-based outpatient pharmacy. The increase prescriptions contributed to $736,562 gross revenue since the initiation of the project in October 2017 (23.6% growth). The total readmission rate calculated from the Premier data set was 9.6 percent (1761/18250), the non-bedside program participant readmission rate was 16.1 percent (1521/9421) and the bedside program participant readmission rate was 5.5 percent (240/4328).
Conclusion: Embedding a transitions of care team within a hospital based outpatient pharmacy led to scientifically identifying patients who were at higher risk of hospital readmission. Proactively reviewing medications before patients discharge promoted identification of barriers to medication access. Additional education was provided to ensure patient understanding of the importance of their medications and potential side effects. This process change has had impact on decreased readmission rates, improving patient outcomes and decreasing additional expenditures to the health system.