Pharmacist Calls to Older Adults with Cognitive Difficulties After Discharge in a Tertiary Veterans Administration Medical Center: A Quality Improvement Program.
J Am Geriatr Soc. 2015 Mar 2;
Authors: Paquin AM, Salow M, Rudolph JL
Abstract
OBJECTIVES: To evaluate the effect of the Pharmacological Intervention in Late Life (PILL) Service, which provides pharmacist telephone follow-up after discharge of older adults from the hospital, on postdischarge acute care utilization.
DESIGN: Retrospective, secondary data analysis of a quality improvement project from 2010 to 2012.
SETTING: Tertiary Veterans Affairs hospital.
PARTICIPANTS: Participants were inpatients aged 65 and older with delirium risk or prescribed a dementia medication (N = 501, mean age 79.5 ± 8.0; 98% male).
MEASUREMENTS: PILL Service pharmacist telephone follow-up included a medication review and reconciliation within 5 days after hospital discharge. The time of the pharmacist call was examined in relation to the outcomes of emergency and urgent care encounters, readmissions, and mortality within 60 days.
RESULTS: The average number of discharge medications was 14.8 ± 5.7 with 2.8 ± 2.2 medication changes and 1.4 ± 1.8 discrepancies between medication order and instruction. After adjustment for age, number of medication changes, and number of discrepancies, every additional 5 minutes of pharmacist call was associated with a 15% reduction in 60-day readmission (adjusted odds ratio (OR) = 0.85, 95% confidence interval (95% CI) = 0.75-0.97) but was not associated with emergency or urgent care encounters (adjusted OR = 1.03, 95% CI = 0.91-1.17) or mortality (adjusted OR = 0.84, 95% CI = 0.58-1.20).
CONCLUSION: Pharmacist-led medication review, reconciliation, and telephone calls after hospital discharge were associated with fewer 60-day hospital readmissions in this quality improvement program.
PMID: 25732548 [PubMed - as supplied by publisher]