Pharmacists with greater role in care prevent repeat hospital visits

March 16, 2017, University of Southern California

Pharmacists given an expanded role in patient oversight can reduce the likelihood of high-risk patients returning to the hospital, according to a new study that underscores a potential cost-saving solution for a growing physician shortage.

"This is the latest study to show that expanding the scope of practice for pharmacists could help patients and still save the health system money," said corresponding author Jeffrey McCombs, an associate professor at USC School of Pharmacy and researcher at the USC Schaeffer Center for Health Policy and Economics. "The evidence is clear that community-based pharmacists can reduce health costs. The question is: Who will pay for expanding their role beyond dispensing medications at the counter?"

The program tested at Kern Health Systems in Bakersfield, Calif., allowed pharmacists with Synergy Pharmacy Solutions to oversee the transition of about 1,100 Medicaid patients discharged from the hospital April 2013 through March 2015.

For the study published on March 15 in the American Journal of Managed Care, USC researchers found that the Synergy pharmacists' transition of care program reduced the 30-day readmission rates for the Kern Health Systems by as much as 28 percent. It also reduced patients' 180-day readmission rates by nearly 32 percent. The study was conducted in partnership with the Komoto Foundation, Synergy Pharmacy Solutions and Kern Health Systems.

Pharmacists for primary care

In the first 30 days of discharge, the Synergy pharmacists counseled the patients to make sure they took their medications as prescribed, followed up with post-discharge appointments, assisted the patients who needed a specialist, arranged for transportation to take them to and from their appointments. They also worked closely with each patient's pharmacy to address any problems or questions that arose regarding their insurance benefits.

The patients identified as high-risk at Kern Health Systems had a history of high medical needs, were discharged with five or more prescriptions, and had been admitted to a hospital within the last 45 days. Most patients in the study were age 45 and older.

For the 30-day discharge period, researchers tracked the progress of 830 patients who were high risk and received the additional pharmacist care. They compared those patients to a control group of 1,005 patients who were not high risk and who had been discharged from neighboring hospitals. Patients with the greatest risk of readmission 30 days after discharge were those with heart disease, chronic obstructive pulmonary disease (COPD), potentially cancerous tissues (neoplasms), digestive diseases, infectious or parasitic diseases. Also at risk were patients who had prescriptions for anti-epileptic drugs, dialysis solutions and dietary supplements.

The patients facing the greatest risk of readmission six months after discharge included those who had been hospitalized before, had COPD, infections, parasitic diseases, diabetes or blood disorders. Patients who were taking dialysis solutions or dietary supplements such as intravenous nutrition were also at greater risk, the researchers wrote.

For the 180-day post-discharge portion of the study, researchers focused on 558 of the patients in the high risk study group to determine whether the pharmacist intervention would have a longer term effect.

After applying an alternative statistical method to adjust for demographics and clinical issues, researchers found that patients in the transition of care program at Kern Family Health Care had a 25 percent lower risk of hospital readmission compared with patients receiving usual care, the study found.

Filling the void

By 2025, the shortfall of primary care physicians in the United States may range between 14,900 to as many as 35,600, the Association of American Medical Colleges estimates. The shortfall for non-primary care specialties could range between 37,400 to 60,300 physicians. Rural areas, where fewer physicians choose to work, are especially hard hit. Kern County, with an estimated 882,000 people, is one such area.

At least four states—California, Montana, New Mexico and North Carolina—have created an "advanced practice of pharmacy" to expand pharmacists' responsibilities beyond filling drug prescriptions, according to the National Governors Association. This new designation allows pharmacists to provide direct, primary patient care. However, the extent of their authority varies from state to state.

"Pharmacists are in a position to fill a lot of the gaps in , but we're in a wait-and-see mode on implementation of expanded practice," said Danielle Colayco, a co-author on the recent study in Kern County and USC School of Pharmacy alumna now at Synergy Pharmacy Solutions.

At his January confirmation hearing, Secretary Tom Price of the U.S. Department of Health and Human Services told congressional members that he would consider expanding the role of pharmacists in patient care.

Currently, federal law does not recognize pharmacists as . The American Pharmacists Association is seeking legislation to allow pharmacists to provide medical services in under-served communities.

McCombs said policymakers need to devise a payment system that incentivizes the pharmacist to provide care while giving the insurance payer some guarantee that they received value for these payments.

Closed health care systems, such as Kaiser Permanente, which operate their own pharmacies see the value and already depend on pharmacists to provide expanded clinical service and supervise the care of on chronic medications, he said.

"Where is the easiest place to go and see a care professional? A pharmacy." McCombs said. "The behind the counter knows quite a lot about keeping us healthy."

Explore further: Embedding non-dispensing pharmacists in medical centers to improve patient outcomes

Related Stories

Embedding non-dispensing pharmacists in medical centers to improve patient outcomes

October 11, 2016
Medication-related problems are one of the most common reasons for patients to be readmitted to hospital.

Changes to hospital electronic health records could improve care of patients on warfarin

January 11, 2017
Warfarin is a commonly prescribed blood thinner used to prevent harmful blood clots. However, the drug requires frequent monitoring, daily dosing and can result in serious negative effects when mixed with vitamin K, a vitamin ...

Innovative collaboration leads to improved discharge outcomes for children with asthma

February 24, 2016
A new study demonstrates that pediatric patients with asthma who left the hospital with their prescription medications made fewer emergency department (ED) visits after they were discharged than if they were discharged still ...

Pharmacists can manage some chronic conditions effectively

April 26, 2016
(HealthDay)—Pharmacists can do an effective job helping chronically ill patients manage their blood pressure, cholesterol, and blood glucose levels if they're allowed to direct patients' health care, according to an evidence ...

Pharmacists report hidden fees that distort prescription costs

July 8, 2016
(HealthDay)—Pharmacists often encounter fees imposed by prescription drug "middlemen" that adversely impact both pharmacies and patients and distort medication costs and reimbursement rates, according to a report from the ...

Pharmacists play key role in improving patient health

June 15, 2015
Over the past nine years, Scot H. Simpson, professor in the faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta, has been studying the role of pharmacists on primary care teams and their impact on ...

Recommended for you

It's not just for kids—even adults appear to benefit from a regular bedtime

September 21, 2018
Sufficient sleep has been proven to help keep the body healthy and the mind sharp. But it's not just an issue of logging at least seven hours of Z's.

Most nations falling short of UN targets to cut premature deaths from chronic diseases

September 21, 2018
People in the UK, US and China have a higher risk of dying early from conditions like cancer, heart disease and stroke than people in Italy, France, South Korea and Australia.

Smart pills dumb down medical care, experts warn

September 21, 2018
Enthusiasm for an emerging digital health tool, the smart pill, is on the rise but researchers at the University of Illinois at Chicago have published a paper in the American Journal of Bioethics that cautions health care ...

China's doctor shortage prompts rush for AI health care

September 20, 2018
Qu Jianguo, 64, had a futuristic medical visit in Shanghai as he put his wrist through an automated pulse-taking machine and received the result within two minutes on a mobile phone—without a doctor present.

Time to ban the sale of energy drinks to children, says senior doctor

September 19, 2018
It's time to bring in laws to ban the sale of caffeinated energy drinks to children and young people in England to tackle the twin epidemics of obesity and mental health problems, argues Professor Russell Viner, President ...

For-profit hospitals correlated with higher readmission rates

September 19, 2018
Patients who receive care in a for-profit hospital are more likely to be readmitted than those who receive care in nonprofit or public hospitals, according to a new study published by University of Illinois at Chicago researchers.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.