Background and Objective
A systematic review and meta-analysis were performed to determine the cumulative effect of pharmacist-led transitions of care on the 30-day all-cause readmission rates of patients with congestive heart failure with the objective to isolate and assess the effect of pharmacy intervention to a condition-specific service. Previous studies that review pharmacist-led transitional care services involve multiple condition-specific services or a pharmacy service integrated into the healthcare team that presents complications in interpreting the independent effectiveness of component services by pharmacy professionals.
A systematic review was conducted using articles identified from MEDLINE, CINAHL, Web of Science, Embase, the Cochrane Library, and clinicaltrials.gov databases for studies on congestive heart failure readmission rates based on transitions of care pharmacist services using detailed inclusion and exclusion criteria. Abstracts were screened for outcome of interest and appropriate transitions of care program structure. Practice and patient characteristics were described and compared to identify current practice trends. A meta-analysis was then performed utilizing previously identified studies from systematic analysis that reported the required data to calculate the effect size. Evidence was reviewed and appraised according to the Newcastle-Ottawa Scale for cohort studies.
The database search produced 443 potential articles for inclusion. Six articles were identified for inclusion in the systematic review based on abstract screening. Of the six articles included in the systematic review, three studies met inclusion criteria for a meta-analysis. Two studies in the meta-analysis stated a significant reduction in the 30-day all-cause readmission rate for patients with congestive heart failure, while the third depicted a reduction in readmission that was found to be non-significant. The pooled effect of the included articles found that pharmacist-led transitions of care services for patients with congestive heart failure had an increased odds to have lower all-cause readmission rates of patients with congestive heart failure (odds ratio = 2.19, 95% confidence interval 1.50–3.20). Based on the meta-analysis of three studies, pharmacist-led transitions of care services significantly reduced the odds of 30-day all-cause readmission rates in patients with congestive heart failure compared with standard-of-care discharge protocols.
Results of the meta-analysis demonstrate the capacity for pharmacist-led transitions of care programs to reduce 30-day all-cause readmission rates in patients with congestive heart failure compared with non-pharmacist discharge care. The financial implications of transitions of care pharmacist involvement have yet to be validated. In general, existing database search results highlight the lack of evidence detailing specific clinical outcomes of pharmacist-led transitions of care services in distinct chronic conditions. Future studies may serve to compare patient-centered outcomes between condition-specific services or across disciplines to provide the most cost-effective delivery of care.
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Mozzafarian D, Benjamin EJ, Go AS, et al. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–60.
The Centers for Medicare and Medicaid Services. Hospital readmissions reduction program. In: Hospital Compare. Date modified: 30 June 2017. https://data.medicare.gov/Hospital-Compare/Hospital-Readmissions-Reduction-Program/9n3s-kdb3/data. Accessed 15 Apr 2019.
Raghupathi W, Raghupathi V. An empirical study of chronic diseases in the United States: a visual analytics approach to public health. Int J Environ Res Public Health. 2018;15(3):431. https://doi.org/10.3390/ijerph15030431.
Fingar KR, Barrett ML, Jiang HJ. A comparison of all-cause 7-day and 30-day readmissions, 2014. HCUP statistical brief #230. Rockville: Agency for Healthcare Research and Quality; 2017.
Boccutti C, Casillas G. Aiming for fewer hospital U-turns: the Medicare Hospital Readmission Reduction Program. San Francisco: Kaiser Family Foundation; 2017.
Joint Commission Center for Transforming Healthcare. Transitions of care: the need for a more effective approach to continuing patient care. Oakbrook Terrace: The Joint Commission; 2012.
The Centers for Medicare and Medicaid Services. Transition of care summary. Eligible Professional Meaningful Use Menu Set Measures Measure 7 of 9. Woodlawn: The Centers for Medicare and Medicaid Services; 2014.
American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Academy. Joint principles of the patient-centered medical home; 2007. https://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf. Accessed 31 Jan 2018.
Rice YB, Barnes CA, Rastogi R, Hillstrom TJ, Steinkeler CN. Tackling 30-day, all-cause readmissions with a patient-centered transitional care bundle. Popul Health Manag. 2016;19(1):56–62.
Fanizza FA, Ruisinger JF, Prohaska ES, et al. Integrating a health information exchange into a community pharmacy transitions of care service. J Am Pharm Assoc. 2018;58(4):442–9. https://doi.org/10.1016/j.japh.2018.02.012(Epub 2018 Apr 4).
Spiegel B, Shane R, Palmer K, et al. Cost-effectiveness of pharmacist post discharge follow-up to prevent medication-related admissions. Am J Manag Care. 2018;6(2):e1–8.
Eapen ZJ, Reed SD, Curtis LH, et al. Do heart failure disease management programs make financial sense under a bundled payment system? Am Heart J. 2011;161(5):916–22.
Kovacik A, Bell PC, King S, et al. Impact of delayed prescription fill on readmission rates for chronic obstructive pulmonary disease and heart failure. J Am Pharm Assoc. 2018;58(4S):S41–5. https://doi.org/10.1016/j.japh.2018.04.017(Epub 2018 May 9).
Mockler M, O’Loughlin C, Murphy N, et al. Causes and consequences of nonpersistence with heart failure medication. Am J Cardiol. 2009;103(6):834–8.
Cox SR, Liebl MG, McComb MN, et al. Association between health literacy and 30-day healthcare use after hospital discharge in the heart failure population. Res Social Admin Pharm. 2017;13:754–8.
Chaudhry SI, Herrin J, Phillips C, et al. Racial disparities in health literacy and access to care among patients with heart failure. J Card Fail. 2011;17(2):122–7.
Monte SV, Passafiume SN, Kufel WD, et al. Pharmacist home visits: a 1-year experience from a community pharmacy. J Am Pharm Assoc. 2016;56:67–72.
Paul S, DiDonato KL, Liu Y, et al. Rural health systems’ perceptions of referral to community pharmacists during transitions of care. J Am Pharm Assoc. 2016;56:562–7.
Gastelurrutia P, Benrimoj SI, Espejo B, et al. Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: impact of a pharmacist in a multidisciplinary HF clinic. J Card Fail. 2011;17(3):217–23.
McClintock S, Mose R, Smith LF. Strategies for reducing the hospital readmission rates of heart failure patients. J Nurse Pract. 2014;10(6):430–3.
Kennelty KA, Witry MJ, Gehring M, et al. A four-phase approach for systematically collecting data and measuring medication discrepancies when patients transition between health care settings. Res Soc Admin Pharm. 2016;12:548–58.
Bailey JE, Surbhi S, Bell PC, et al. SafeMed: using pharmacy technicians in a novel role as community health workers to improve transitions of care. J Am Pharm Assoc. 2015;56:73–81.
Bleske BE, Dillman NO, Cornelius D, et al. Heart failure assessment at the community pharmacy level: a feasibility pilot study. J Am Pharm Assoc. 2014;54:634–41.
Ploenzke C, Kemp T, Naidl T, et al. Design and implementation of a targeted approach for pharmacist-mediated medication management at care transitions. J Am Pharm Assoc. 2016;56:303–9.
Kilethermes MA. Understanding healthcare basics. Pharm Times. 2017;23(7):57–68.
U.S. Bureau of Labor Statistics. Employment projections data for pharmacists, 2016–26, Publication no. 29-1051. Washington, DC: Department of Labor; 2018.
Hussey LC, Hardin S, Blanchette C. Outpatient costs of medications for patients with chronic heart failure. Am J Crit Care. 2002;11:474–8.
Ni W, Colayco D, Hashimoto J, et al. Impact of a pharmacy-based transitional care program on hospital readmissions. Am J Manag Care. 2017;23(3):170–6.
Milfred-LaForest SK, Gee JA, Pugacz AM, et al. Heart failure transitions of care: a pharmacist-led post discharge pilot experience. Prog Cardiovasc Dis. 2017;60:249–58.
Salas CM, Miyares MA. Implementing a pharmacy resident run transition of care service for heart failure patients: effect on readmission rates. Am J Health Syst Pharm. 2015;72:S43–7.
Kalista T, Lemay V, Cohen L. Postdischarge community pharmacist-provided home services for patients after hospitalization for heart failure. J Am Pharm Assoc. 2015;55:438–42.
Hale GM, Hassan SL, Hummel SL, et al. Impact of a pharmacist-managed heart failure postdischarge (bridge) clinic for veterans. Ann Pharmacother. 2017;51(7):555–62.
Truong JT, Backes AC. The impact of a continuum of care resident pharmacist on heart failure readmissions and discharge instructions at a community hospital. SAGE Open Med. 2015;3:2050312115577986.
Moye PM, Chu PS, Pounds T, Thurston MM. Impact of a pharmacy-led intervention program on the readmission rate of elderly patients with heart failure. Am J Health Syst Pharm. 2018;75(4):183–90.
Rodrigues CR, Harrington AR, Murdock N, et al. Effect of pharmacy-supported transition-of-care interventions on 30-day readmissions: a systematic review and meta-analysis. Ann Pharmacother. 2017;51(10):866–89.
Heaton PC, Frede S, Kordahi A, et al. Improving care transitions through medication therapy management: a community partnership to reduce readmissions in multiple health-systems. J Am Pharm Assoc. 2019. https://doi.org/10.1016/j.japh.2019.01.005(Epub ahead of print).
Feldman JD, Otting RI, Otting CM, Witry MJ. A community pharmacist-led service to facilitate care transitions and reduce hospital readmissions. J Am Pharm Assoc. 2018;58:36–43.
World Health Organization. Classifying healthcare workers: mapping occupations to the international standard classification. Geneva: World Health Organization; 2010.
We are grateful to the authors of the contributing works, Ms. Debbie Lynn for her contributions to presenting this work at the American Society of Hospital Pharmacists Midyear Clinical Meeting 2018, and Nicole McKay for her assistance acquiring database access.
No funding was received for the conduct of this study.
Conflict of interest
Connor McKay, Chanhyun Park, Jongwha Chang, Marcia Brackbill, Jae-Young Choi, Jung Heon Lee, and Sean Hyungwoo Kim have no conflicts of interest that are directly relevant to the content of this article.
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McKay, C., Park, C., Chang, J. et al. Systematic Review and Meta-analysis of Pharmacist-Led Transitions of Care Services on the 30-Day All-Cause Readmission Rate of Patients with Congestive Heart Failure. Clin Drug Investig 39, 703–712 (2019). https://doi.org/10.1007/s40261-019-00797-2