Category: Professional Posters
Purpose: Patients that have undergone complicated inpatient admissions may be at a higher risk of medication issues due to changes and additions in therapy. Maintaining an updated medication list for them can be challenging. These patients may qualify for home health care due to limitations in mobility and transportation and therefore, receive routine visits from healthcare professionals to assist with chronic illnesses. The purpose of this study was to determine if the reason for readmission was due to a medication-related issue and assess the value of a pharmacist in reviewing these patients.
Methods: This prospective cohort study included all patients enrolled in home health services admitted to an inpatient unit. Patients were excluded if they were admitted for congestive heart failure due to a concurrent study on this patient population. Those treated and released from the emergency department were also excluded. The pharmacist evaluated medical records, conducted patient interviews, and addressed discrepancies in the medication reconciliation. The primary outcome was the number of patients admitted due to a medication-related event. Secondary outcomes included the number and type of discrepancies identified and the number of patients readmitted within 30 days for a medication-related issue. Patients were assessed daily and counseled on newly initiated medications in the hospital. Patients also received a follow-up phone call post-discharge to address questions of therapy and reiterate adherence.
Results: A total of 41 patients were evaluated. The average age of this patient population was 76 years with about half being male. Approximately 30 percent of home health patients were admitted to the hospital due to a medication-related issue. The classes of medications most frequently causing hospital admission were antibiotics due to failing outpatient therapy, as well as antidiabetic medications causing hypoglycemia. Other medication classes included antihypertensives and serotonin-norepinephrine reuptake inhibitors. The pharmacist identified an average of two medication discrepancies per patient. The most common reason for deviances included omission of a medication the patient was actively taking, followed by incorrect dosing, inappropriate addition of a medication, duplicate therapy, and lastly incorrect indication. Follow-up phone calls were conducted on 25 patients. The remaining patients either expired, were discharged to another facility, or unavailable. During post-discharge phone calls, adherence was assessed and reinforced, patient concerns were addressed and additional questions regarding medications were answered. A limitation of this research was that not all patients were able to be interviewed and counseled inpatient due to being discharged prior to speaking with the pharmacist. Other limitations included a small sample size and limited study duration of two months.
Conclusion: Home health patients can be at risk for readmissions due to complex medication regimens. The integration of pharmacy services is beneficial in bridging gaps between health care settings. Pharmacists are able to identify discrepancies in the medication reconciliation and rectify such a comprehensive list. Interviewing patients is very beneficial, however, during this study the pharmacist was not able to speak with all patients due to time constraints. The study has been continued for another month to increase sample size. Overall, inclusion of a pharmacist in the medication evaluation decreased inaccuracies in therapy and addressed barriers in understanding medications.