title: Impact of pharmacist-conducted medication reconciliation at discharge on readmissions of elderly patients with COPD.
abstract: OBJECTIVE
  Beginning in fiscal year 2015, the Centers for Medicare and Medicaid Services will measure all-cause readmissions for patients admitted for exacerbation of chronic obstructive pulmonary disease (COPD). Hospitals will incur a payment penalty for unplanned 30-day readmissions. Elderly patients frequently present a challenge because of polypharmacy, which contributes to a greater risk for medication-related readmissions.
  
  
  OBJECTIVE
  To determine whether pharmacist-conducted medication reconciliation at discharge decreased medication discrepancies and reduced 30-day readmissions for elderly patients with COPD.
  
  
  METHODS
  Patients aged 65 years and older admitted for a COPD exacerbation between January 31, 2012, and February 29, 2012, were included. The pharmacist reviewed the discharge form for discrepancies. Patients who were readmitted within 30 days of discharge were identified. The rate of 30-day readmission was compared with baseline data. Length of stay and cost for admission versus readmission were also assessed.
  
  
  RESULTS
  A total of 29 patients were admitted for a COPD exacerbation; 6 medication discrepancies were identified and reported to prescribers. Four patients were readmitted within 30 days of discharge. The 30-day readmission rate was lower than the baseline rate (16.0% vs 22.2%). When comparing admissions with readmissions, a slight reduction in average length of stay and slight increase in cost was observed.
  
  
  CONCLUSIONS
  Pharmacist-conducted medication reconciliation at discharge decreased discrepancies for elderly patients admitted for exacerbation of COPD. The 30-day readmission rate could be decreased further by expanding pharmacist responsibilities during transitions of care. This includes patient counseling, tracking outpatient adherence, selecting affordable medications, and expanding the process to include other chronic disease states.
authors.affiliation: University of Rhode Island College of Pharmacy, Kingston, RI, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Eisenhower
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology*; D014481:United States
keywords: elderly; medication reconciliation; readmission