Impact of Pharmacist Post-discharge Phone Calls on Hospital Readmission and Patient Medication Literacy and Adherence

Cedars-Sinai Medical Center

Status: Terminated

Conditions: Medication Adherence & Literacy to Predict Readmission; Post-discharge Pharmacist Counseling to Prevent Readmissions

Treatments: Other: Post-discharge counseling on medication adherence & literacy

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02031406

KL2TR000122-00034358

KL2TR000122 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

A significant portion of avoidable healthcare expenditures has been attributed to preventable hospital readmissions; thus, reducing hospital readmission rates has become a national healthcare agenda item. Despite much study of this topic, efforts to date have not been especially fruitful in either predicting which patients will require hospital readmission. Preventing readmissions has been even more difficult.

We recently examined a pharmacist intervention that assessed patients' medication literacy and adherence at hospital admission. In this retrospective data, low medication adherence levels were predictive of hospital readmission. There was a non-significant trend between low medication literacy and increased hospital readmissions.

We have now decided to prospectively study this intervention. Prospective study will allow for several improvements on our prior work.

1. We have consulted the literature to more carefully examine existing instruments to measure medication adherence and literacy. Based on this review, and based on our prior results, we have made adjustments to these instruments which should improve reliability, validity, and granularity.
2. In our retrospective work, our intervention of pharmacist counseling was not randomized. Although there were large differences in readmission rates between the patients selected to receive counseling and those who were not thought to require it, there may have been unmeasured confounding variables. Randomizing this intervention will greatly enhance the likelihood that we are comparing two similar groups of patients.

Enrollment: 155 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

≥10 chronic prescription medications On anticoagulants Diagnosis of CHF, AMI On narrow therapeutic index drugs E.g. valproic acid, phenytoin, lithium, digoxin History of transplant AND not admitted by transplant team

Exclusion criteria

Trauma patients Pediatric patients History of transplant and admitted to the transplant team Patients admitted from or discharged to a SNF or hospice Non-English speaking patients

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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155 participants in 2 patient groups

Usual care

No Intervention group

Description:

No extra post-discharge pharmacist counseling is explicitly provided to patients, although some patients may receive it depending on their care setting

Post-discharge pharmacist counseling

Experimental group

Description:

Patients will receive post-discharge telephonic pharmacist counseling at around 72 hours after hospital discharge.

Treatment:

Other: Post-discharge counseling on medication adherence & literacy