Derek McFerran, PharmD

High hospital readmission rates have historically been an indicator of poor quality care. They are disruptive to caregivers and providers as well as to patients. Readmissions cost the healthcare system billions each year and put patients at risk for hospital-acquired infections and complications. 

Studies, notably by Dr. Stephen Jencks, have shown this to be a pervasive problem, resulting in a considerable cost to fee-for-service (FFS) Medicare. Jencks estimated that readmissions within 30 days of discharge cost Medicare more than $17 billion annually. The problem is not limited to Medicare patients alone. Adult Medicaid patients are readmitted about twice as frequently as privately insured patients, regardless of the readmission period. 

Healthcare practitioners and researchers indicate that high readmission rates for patients with chronic diseases and others may be due to various factors that fall under a range of causes, such as: 

Medication Therapy Management (MTM) is one way pharmacists can help combat this ongoing concern. MTM includes analytical, consultative, educational, and monitoring services as well as numerous other tools and strategies that can be used to diminish readmission rates. MTM will increase patient adherence and increase understanding of therapy as well as control costs, while preventing drug interactions, duplications, and complications. 

MTM enhances a patient's understanding of appropriate drug use, which increases detection of adverse events. It targets vulnerable points of care, such as chronic disease states and complex or cognitively impaired patients, as well as transition points of care, while allowing pharmacists to intervene for medication-related problems, and enables them to refer patients to other practitioners (PCP, NP, LICSW) if necessary. 

There are many disease states, such as CHF, COPD, and diabetes, for which MTM can prevent hospitalizations. This model empowers patients to take on a more active role in care management. Care becomes not only collaborative but also patient-centered. Patients walk away with a better understanding of their conditions and how to manage them. 

Without MTM therapy, the impact on patient care and readmissions is extensive. The quality of patient care and outcomes would decrease, while medication-related problems, cost, and nonadherence would rise, worsening difficulties we face today. 

Readmissions, while not all avoidable, are often preventable. To assess your practice's aptitude in readmission management, you can use the following questions as a guide. 

Pharmacists have not only a dynamic and diverse knowledge base but also effective tools and strategies. They can educate, encourage, and empower patients through MTM therapy and other techniques, which in turn will lead to decreased overall hospitalizations and readmissions.  

 is a clinical pharmacist with Tufts Health Plan in Watertown, Mass.

Articles

Hospital readmissions constitute one of the most significant problems in healthcare. Medication therapy management is one way to reduce the problem.