Clinical Pharmacists Value During Transition of Care Services Evaluated


During this period, pharmacists can optimize medications, monitor adherence, and improve access.

Incorporating the services of a clinical pharmacist within post-discharge standard of care practices can reduce 30-day all-cause readmission rates, particularly among geriatric patients, according to a poster presented at the 2022 American Society of Health-System Pharmacists Summer Meeting and Exhibition, held in Phoenix, Arizona.

Through a prospective, single-center intervention study with a historical control group comparator, researchers sought to evaluate the how a pharmacist-led transition of care service might impact geriatric patients in one senior care clinic. The intervention took place between October 2020 and January 2021 and included patients with an established clinic primary care provider (PCP) who were discharged home. Historical control group data were collected from electronic medical records (EMR) from patients discharged home the year prior.

Pharmacists initiated a post-discharge phone call 3 to 5 days after discharge in order to identify any medication-related interventions before the patient’s next visit with their PCP. These interventions—part of a collaborative practice agreement—included medication optimization, reconciliation, and adherence, as well as improving medication access. These interviews were documented in the EMR and reviewed by a pharmacist at the conclusion of the intervention period to determine the differences in 30-day all-cause hospital readmission rates in both groups.

Thirty-seven patients participated in the intervention, compared with the 37 patients in the control group. Among the intervention patients, 87.5% were contacted successfully 3.44 days after discharge. Sixty-five interventions were identified, 75.3% of which were implemented by PCPs. Five patients required hospital readmission within 30 days after discharge, vs the historical baseline of 7 patients. One and 2 patients in the intervention and control groups, respectively, visited the ED within the 30-day period, but were not admitted.

At the conclusion of the intervention, a 3.55 positive return on investment value was calculated based on average pharmacist salary. Provider satisfaction ratings were “strongly positive,” and they “highly recommended” continuing the program.

“This study is the first to evaluate the impact of pharmacist transitional care services within a senior care primary care setting on reducing readmission rates,” the researchers concluded. “We hope that our findings impact other institutions to embed clinical pharmacist services within routine post-discharge standard of care.”


Shieh J. Impact of a pharmacist transitional care service pilot on senior care patients at an academic medical center. Presented at: American Society of Health-Systems Pharmacists Summer Meetings and Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 9-T.

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