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Multifaceted intervention prevents hospital readmissions
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A multifaceted clinical pharmacist intervention that is based on patient-centered medication review, motivational interviewing and follow-up helps to decrease the number of hospital readmissions and ED visits among patients with polypharmacy, according to a study published in JAMA Internal Medicine.
“Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society,” Lene Vestergaard Ravn-Nielsen, MSc, from Hospital Pharmacy of Funen, Denmark, and colleagues wrote.
Ravn-Nielsen and colleagues performed a randomized clinical multicenter study to investigate whether a multifaceted pharmacist intervention including medication review, patient interview and follow-up can prevent readmissions to the hospital and ED visits. The researchers enrolled 1,467 consecutive medical patients aged 18 years or older who were receiving at least five medications (polypharmacy) and were admitted to an acute admission ward (mean age, 72 years; 46.3% men).
Participants were randomly assigned to one of three groups: no intervention (usual care; n = 498), a basic intervention consisting of only a medication review (n = 493) or an extended intervention consisting of a medication review, three motivational interviews and a follow-up with the primary care physicians, pharmacy and nursing home (n = 476).
The study indicated that patients in the extended intervention group had a significantly reduced rate of hospital readmissions within 30 days (HR = 0.62; 95% CI, 0.46-0.84) or within 180 days (HR = 0.75; 95% CI, 0.62-0.90) after inclusion, as well as the rate of readmissions or ED visits within 180 days (HR = 0.77; 95% CI, 0.64-0.93), compared with those in either the no intervention or basic intervention groups.
Drug-related readmissions were not significantly reduced within 30 days (HR = 0.65; 95% CI, 0.39-1.09) and within 180 days (HR = 0.80; 95% CI, 0.59-1.08) after inclusion. In addition, drug-related deaths were not significantly reduced within 180 days (HR = 0.83; 95% CI, 0.22-3.11). For the extended intervention, the number needed to treat for readmission or an ED visit within 180 days was 12.
“For hospitalized patients with polypharmacy, this multifaceted intervention that included a structured, patient-centered medication review, a 30-minute patient interview based on motivational interviewing (a coaching method aiming to ensure adequate patient behavior in order to prevent health related events) and a summary note for and follow-up calls with a primary care provider can reduce the short- and long-term rates of readmissions,” Ravn-Nielsen told Healio Internal Medicine.
Barriers to implementing this multifaceted intervention include cost-effectiveness, lack of properly trained clinical pharmacists and obtaining a large budget, according to the researchers.
“Future studies might be able to more accurately identify those at high risk of drug-related problems, allowing for a more focused intervention,” Ravn-Nielsen and colleagues concluded. “Finally, given the ambiguous results from other interventions studies, seeing our findings verified in other settings would be desirable.” – by Alaina Tedesco
Disclosure: Ravn-Nielsen reports receiving grants from the Hospitals Pharmacies’ and Amgros’ Research Development Foundation, two public regional foundations and Actavis Foundation. Please see study for all other authors’ relevant financial disclosures.