Pharmacist follow-up can reduce readmission rates of lower-risk Medicare patients

April 16, 2014

Study finds that targeting the pharmacy service to patients who are most likely to benefit is important.

Low-risk Medicare patients entering home healthcare who received a medication therapy management (MTM) consultation with a pharmacist over the phone  were three times less likely to be hospitalized within the next two months, while those at greater risk saw no benefit, according to a study published in Health Services Research.

A team of Purdue University researchers collaborated with Amedisys Inc., a home healthcare organization on the study, and pharmacists from Curant Health (formerly HealthStat Rx) provided the MTM intervention. Amedisys Inc. funded the research.

The study

In the randomized, controlled trial, researchers followed 895 Medicare patients from 40 Amedisys home healthcare centers throughout the United States; 415 patients received the intervention, which consisted of an initial phone call from a pharmacy technician to verify active medications, a medication regimen review made by a pharmacist, and follow-up phone calls from a pharmacist seven days later and as needed for 30 days.

The results showed no significant overall difference in the 60-day probability of hospitalization between those who received MTM by telephone and those who did not.

However, when the patients were evaluated on the basis of their risk profiles, those in the lowest-risk group who received the service were three times more likely to remain out of the hospital 60 days after entering into home healthcare.

 

Targeted services

“Clinical services regarding medication management provided by pharmacists during the transition of care to home health can reduce hospitalization,” said study leader Alan J. Zillich, PharmD, research scientist, Roudebush VA Medical Center, Center for Healthcare Information and Communication.

He continued, “Targeting the pharmacy service to patients who are most likely to benefit is important. The modality of service delivery - telephone, face-to-face, videoconference, in-home - that will optimize outcomes requires further study.”

The study helped determine which patients benefit most from telephonic MTM and a way to identify them through a standardized risk score, said Zillich, who also serves as associate professor of pharmacy practice at Purdue.

Who benefits

According to Zillich, the most common types of medication-related errors are identified soon after transitions of care take place and the first days are the most important.

"Most elderly patients requiring home healthcare are dealing with multiple chronic conditions and taking multiple medications," he said in a press release. "When we say ‘low-risk’ patients in this context, we are talking about the least sick of a very sick group of patients. I'm not sure why they benefited so much from this intervention while the other groups did not. One theory is that they are better able to receive and retain guidance from a pharmacist over the phone, and perhaps face-to-face medication therapy management would better help the higher-risk patients."