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    The role of the pharmacist in preventing hospital readmissions

    At Wagner Pharmacies, with four locations in Clinton, Iowa, we have developed an industry-leading, data-driven clinical program for improving patient outcomes within the new healthcare landscape. Focused on supporting our patients in medication therapy management and medication adherence, board-certified ambulatory care pharmacists have played a central role in the development of this program.

    Background

    Healthcare reform is creating a shift away from volume-based to value-based care, with a renewed focus on improving patient outcomes and quality care. As trusted medical professionals with frequent access to patients, pharmacists are uniquely positioned to play a key role in positively affecting patient outcomes and reducing hospital readmissions, as well as ultimately reducing healthcare costs.

    Under the Affordable Care Act, hospitals are measured on performance with the Hospital Readmissions Reduction Program (HRRP). HRRP, administered by the Centers for Medicare and Medicaid Services (CMS), penalizes hospitals with excess readmissions and admissions within 30 days of discharge for a number of conditions, including pneumonia, heart failure, myocardial infarction, and joint replacement. This year, close to 80% of the 3,400 hospitals evaluated received financial penalties projected to cost an estimated $428 million in fiscal year 2015.1,2 It is possible that penalties could be avoided through greater medication adherence. 

    Why is it an issue when nonadherence follows an inpatient procedure or a hospital stay? A 2013 study showed that medication nonadherence costs the U.S. healthcare system an estimated $290 billion annually in unnecessary spending.3

    Experience

    Patients are often discharged from the hospital following an inpatient stay with several new prescriptions and a new medication regimen, and the new medications are often additions to what the patients were already prescribed for preexisting chronic conditions.

    We see patients in our pharmacies who have not received sufficient in-hospital education to understand what each medication is for or how the new medications will interact with existing medications. Moreover, they may not be willing (or able) to pay for all of the various drugs prescribed. Once a patient leaves the facility, the prescribing physician is often no longer in communication with the patient, and the patient is left to make key decisions about the medication regimen that are based on a lack of understanding or financial constraints, or both.

    In our experience, decisions an individual makes at the pharmacy counter can have a negative impact on medication therapy and subsequently on health outcomes, an impact that frequently leads to hospital readmission. In turn, such hospital readmissions incur financial penalties for the institution and hurt the hospital’s bottom line.

    We believe that pharmacists can improve outcomes and reduce readmissions through implementation of a robust medication adherence program supported by patient education and internal communication. Our pharmacies have had great success through a program we developed called "MedAssist," which uses the following tools:

    ·      Industry data on the effectiveness of medication synchronization and adherence programs

    ·      Ongoing staff and patient education

    ·      One-on-one patient interviews with a clinical pharmacist

    ·      Adherence packaging that simplifies medication regimens

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