Clinical Pharmacy Interventions in Reducing Medication-Related Hospital Readmissions

Authors

  • Majed Ateeq Alzahrani
  • Shuruq Saqer Salem Alruwaili
  • Aminah Alfahhat M Alanazi
  • Badr Kheleif A Alenezi
  • Sultan Nawar Alrubaiei
  • Salman Nawar Alrubaiei
  • Ali Hotan Mohamed Alghamdi
  • Abdulhadi Hammad ALZaidi
  • Rakan Ali A Alruwaili
  • May Khalid Faleh Alsuliman
  • Ziyad Abdullah Saleh Al Rudayan

DOI:

https://doi.org/10.22399/ijcesen.4645

Keywords:

Clinical pharmacy interventions, medication-related hospital readmissions, medication reconciliation, patient education, clinical decision support

Abstract

Clinical pharmacy interventions play a pivotal role in mitigating medication-related hospital readmissions, a significant concern in healthcare due to the associated economic burden and patient morbidity. These interventions encompass a range of pharmacist-driven activities, including medication reconciliation, patient education, and the implementation of clinical decision support systems. By conducting comprehensive reviews of patients' medication regimens during hospital admissions and discharges, pharmacists can identify potential drug interactions, dosing errors, and duplications. This proactive approach ensures that patients are prescribed appropriate medications, minimizing adverse drug events and enhancing therapeutic outcomes. Moreover, engaging patients through educational initiatives equips them with the knowledge to adhere to their prescribed medication regimens post-discharge, further reducing the risk of readmission. Additionally, research has demonstrated that the involvement of clinical pharmacists in multidisciplinary healthcare teams can lead to significant improvements in medication management processes. Interventions such as follow-up consultations, telepharmacy services, and personalized medication plans have been shown to foster better communication between healthcare providers and patients. These strategies not only improve medication adherence but also empower patients to take an active role in managing their health conditions. By addressing the complexities of medication therapy and enhancing continuity of care, clinical pharmacy interventions serve as a critical component in efforts to reduce hospital readmissions, ultimately leading to better patient outcomes and decreased healthcare costs.

References

1. Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Archives of Internal Medicine. 2009;169(9):894–900.

2. Bülow C, Clausen SS, Lundh A, et al. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database of Systematic Reviews. 2023;1(1):CD008986.

3. Graabæk T, Terkildsen BG, Lauritsen KE, et al. Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study. Therapeutic Advances in Drug Safety. 2019;10:2042098619858049.

4. Gallagher D, Greenland M, Lindquist D, et al. Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention. BMJ Open Quality. 2022;11(1):e001560.

5. Walker PC, Bernstein SJ, Jones JNT, et al. Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study. Archives of Internal Medicine. 2009;169(21):2003–10.

6. Kempen TGH, Bertilsson M, Hadziosmanovic N, et al. Effects of hospital-based comprehensive medication reviews including postdischarge follow-up on older patients’ use of health care: a cluster randomized clinical trial. JAMA Network Open. 2021;4(4):e216303.

7. Miller D, Ramsey M, L’Hommedieu TR, et al. Pharmacist-led transitions-of-care program reduces 30-day readmission rates for Medicare patients in a large health system. American Journal of Health-System Pharmacy. 2020;77(12):972–8.

8. Uitvlugt EB, Janssen MJA, Siegert CEH, et al. Medication-related hospital readmissions within 30 days of discharge: prevalence, preventability, type of medication errors and risk factors. Frontiers in Pharmacology. 2021;12:567424.

9. Rottman-Sagebiel R, Cupples N, Wang CP, et al. A pharmacist-led transitional care program to reduce hospital readmissions in older adults. Federal Practitioner. 2018;35(12):42–50.

10. Phatak A, Prusi R, Ward B, et al. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs. Journal of Hospital Medicine. 2016;11(1):39–44.

11. Ravn-Nielsen LV, Duckert M-L, Lund ML, et al. Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission: a randomized clinical trial. JAMA Internal Medicine. 2018;178(3):375–82.

12. Daliri S, Boujarfi S, el Mokaddam A, et al. Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis. BMJ Quality & Safety. 2021;30(2):146–56.

13. Schönenberger N, Blanc AL, Hug BL, et al. Developing indicators for medication-related readmissions based on a Delphi consensus study. Research in Social and Administrative Pharmacy. 2024;20(6):92–101.

14. PCNE Classification for Drug-Related Problems V9.1. Pharmaceutical Care Network Europe Association; 2020.

15. Odeh M, Scullin C, Fleming G, et al. Ensuring continuity of patient care across the healthcare interface: telephone follow-up post-hospitalization. British Journal of Clinical Pharmacology. 2019;85(3):616–25.

16. Dalleur O, Beeler PE, Schnipper JL, et al. 30-day potentially avoidable readmissions due to adverse drug events. Journal of Patient Safety. 2021;17(5):e379–86.

17. Witherington EMA, Pirzada OM, Avery AJ. Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study. Quality & Safety in Health Care. 2008;17(1):71–5.

18. March KL, Peters MJ, Finch CK, et al. Pharmacist transition-of-care services improve patient satisfaction and decrease hospital readmissions. Journal of Pharmacy Practice. 2022;35(1):86–93.

19. Rafferty A, Denslow S, Michalets EL. Pharmacist-provided medication management in interdisciplinary transitions in a community hospital (PMIT). Annals of Pharmacotherapy. 2016;50(8):649–55.

20. Linkens A, Milosevic V, van der Kuy PHM, et al. Medication-related hospital admissions and readmissions in older patients: an overview of literature. International Journal of Clinical Pharmacy. 2020;42(5):1243–51.

21. Harris M, Moore V, Barnes M, et al. Effect of pharmacy-led interventions during care transitions on patient hospital readmission: a systematic review. Journal of the American Pharmacists Association. 2022;62(5):1477.

22. Mekonnen AB, McLachlan AJ, Brien JA. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):e010003.

23. Vest JR, Gamm LD, Oxford BA, et al. Determinants of preventable readmissions in the United States: a systematic review. Implementation Science. 2010;5:88.

24. El Morabet N, Uitvlugt EB, van den Bemt BJF, et al. Prevalence and preventability of drug-related hospital readmissions: a systematic review. Journal of the American Geriatrics Society. 2018;66(3):602–8.

25. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the medicare fee-for-service program. New England Journal of Medicine. 2009;360(14):1418–28.

26. Gurwitz JH, Kapoor A, Garber L, et al. Effect of a multifaceted clinical pharmacist intervention on medication safety after hospitalization in persons prescribed high-risk medications: a randomized clinical trial. JAMA Internal Medicine. 2021;181(5):610–8.

27. Fosnight S, King P, Ewald J, et al. Effects of pharmacy interventions at transitions of care on patient outcomes. American Journal of Health-System Pharmacy. 2020;77(12):943–9.

28. Whitaker AS, Cottrell WN. What proportion of unplanned re-presentations to an emergency department are medication related and preventable? Journal of Pharmacy Practice and Research. 2019;49(6):546–56.

29. Parekh N, Ali K, Stevenson JM, et al. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. British Journal of Clinical Pharmacology. 2018;84(8):1789–97.

30. Shanika LGT, Jayamanne S, Wijekoon CN, et al. Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka. Bulletin of the World Health Organization. 2018;96(3):155–64.

31. Al-Hashar A, Al-Zakwani I, Eriksson T, et al. Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use. International Journal of Clinical Pharmacy. 2018;40(5):1154–64.

32. Kripalani S, Roumie CL, Dalal AK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Annals of Internal Medicine. 2012;157(1):1–10.

33. Lam SW, Sokn E. Effect of pharmacy-driven bedside discharge medication delivery program on day 30 hospital readmission. Journal of Pharmacy Practice. 2020;33(5):628–32.

34. Kelly WN, Ho M-J, Bullers K, et al. Association of pharmacist counseling with adherence, 30-day readmission, and mortality: a systematic review and meta-analysis of randomized trials. Journal of the American Pharmacists Association. 2021;61(3):340.

35. McConachie SM, Raub JN, Yost R, et al. Evaluation of a multidisciplinary approach to reduce internal medicine readmissions using a readmission prediction index. American Journal of Health-System Pharmacy. 2020;77(12):950–7.

36. Cooper JB, Jeter E, Sessoms CJ. Rates and types of medication-related problems in patients rehospitalized within 30 days of discharge from a community hospital. Journal of Pharmacy Technology. 2020;36(2):47–53.

37. Chiu P, Lee A, See T, et al. Outcomes of a pharmacist-led medication review programme for hospitalised elderly patients. Hong Kong Medical Journal. 2018;24(2):98–106.

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Published

2024-09-30

How to Cite

Majed Ateeq Alzahrani, Shuruq Saqer Salem Alruwaili, Aminah Alfahhat M Alanazi, Badr Kheleif A Alenezi, Sultan Nawar Alrubaiei, Salman Nawar Alrubaiei, … Ziyad Abdullah Saleh Al Rudayan. (2024). Clinical Pharmacy Interventions in Reducing Medication-Related Hospital Readmissions. International Journal of Computational and Experimental Science and Engineering, 10(4). https://doi.org/10.22399/ijcesen.4645

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Section

Research Article