Analysis of community pharmacist recommendations from a transitions of care study

Abstract

AbstractObjectiveCommunity pharmacists are often the first healthcare professional encountered following discharge from a hospital, but what extent of services provided is not fully described across a variety of community pharmacy settings. Our objective was to capture and report recommendations made by community pharmacists during a transitions of care interventional study and to determine if visit‐related factors affected the risk of readmission.MethodsThe content of pharmacists' notes were analyzed from encounters during a transitions of care interventional study for patients discharged from a hospital with five high‐risk conditions (heart failure, acute myocardial infarction, diabetes, pneumonia, or chronic obstructive pulmonary disease), where the primary purpose of the intervention was to enhance inpatient and community pharmacist communication to improve patient care. Summary statistics were utilized to describe the content of pharmacist notes and actions, and a Cox proportional hazards model was used to test for the impact of several patient or visit‐related characteristics on the risk of 90‐day readmissions.ResultsAs part of an interventional study, patients spent an average of 9 minutes (standard deviation [SD] 6.9) with pharmacists during each visit and had three visits on average within 90‐day of discharge. Responses to checklist questions were documented on 99% of notes, and pharmacists provided recommendations 58% of the time. Recommendations varied by condition with the most frequent being adherence (10%), vaccinations (8%), and disease monitoring (7%). In multivariate models, readmission was higher among patients with highest comorbidity (hazard ratio [HR] = 10.18, 95% confidence interval [CI], 3.53‐29.36), two or more medications added at discharge (HR = 3.83, 95% CI, 1.49‐9.82), or vaccine gaps (HR = 3.51, 95% CI, 1.09‐11.33).ConclusionsIn a transitions of care service, community pharmacists actively engaged patients and caregivers at regular intervals, providing largely patient‐oriented recommendations during relatively short consultation encounters. Patient and visit‐related items associated with higher readmission risk such as higher comorbidity, medication additions, and incomplete vaccinations signal opportunity for community pharmacist‐led interventions to improve care of patients in the postdischarge period.