Abstract 17643: Pharmacist-Driven Inpatient to Tele-Clinic Transitions of Care: The PICTOC Quasi-Experiment to Reduce 30-day Readmissions in Patients With Heart Failure

Abstract

Introduction: Successful transitional care models leverage the same clinician, typically nurses, to deliver and coordinate interventions across settings for patients with heart failure. However, pharmacists may be well-suited to lead these efforts given that medication-related issues are often drivers for 30-day readmission. We implemented a pharmacist-driven inpatient to tele-clinic transitions of care (PICTOC) program and evaluated its impact on readmissions at an academic medical center. Methods: Pharmacists provided hospital-based transitional care services two half-days per week between June 2020 and September 2022. They identified patients admitted for heart failure who were established at or referred to specific primary care practices. Patients were prioritized by discharge date and interventions included medication optimization, education, appointment scheduling within 14 days, and a post-discharge telemedicine visit with the pharmacist. A quasi-experimental design was used to compare the 30-day readmission rate in PICTOC group to a control group of patients who met eligibility criteria but were discharged prior to receiving the intervention. Intention-to-treat and per-protocol analyses were performed using Chi-square test. Results: There were 1346 patients included. The mean (SD) age was 67.0 (13.8) years, 51.3% were male and 503 patients received the PICTOC intervention. The 30-day readmission rate in the intention-to-treat group was 15.5% compared to 17.9% in the control group (p=0.25). Among the 75% of patients who attended the pharmacist telemedicine visit per protocol, the readmission rate was 13.5% (p=0.059). Patients in PICTOC group had higher rates of scheduled follow-up with primary care (59.2% vs. 53.7%, p=0.048) and cardiology (48.7% vs. 37.6%, p=0.0001). Appointment attendance with primary care was significantly higher in the PICTOC group (72.5% vs. 61.8%, p=0.0023) and trended higher with cardiology (69.4% vs. 65.9%, p=0.39). Conclusion: The PICTOC program improved transitional care quality and outcomes among patients with heart failure. Additional analyses of this novel care delivery model are warranted.