title: Evaluation of a pharmacy-driven inpatient discharge counseling service: impact on 30-day readmission rates.
abstract: OBJECTIVE
  To evaluate the impact of a pharmacy-driven inpatient discharge counseling service on 30-day readmission rates.
  
  
  METHODS
  A retrospective electronic chart review was performed comparing internal medicine patients who received pharmacy discharge counseling with those who received the standard discharge process between May 1, 2011, and March 28, 2012.
  
  
  METHODS
  A community teaching hospital's internal medicine service.
  
  
  METHODS
  A total of 1,536 patients discharged from the internal medicine service were eligible for study inclusion. A total of 228 of these patients received pharmacy discharge counseling.
  
  
  METHODS
  Patients were screened for readmission risk. For those patients who scored as high risk, an attempt was made to provide pharmacy counseling and a discharge medication list.
  
  
  METHODS
  The primary endpoint was to evaluate whether pharmacy discharge counseling had an impact on readmission rates. An additional outcome was to measure the quantity of pharmacy interventions.
  
  
  RESULTS
  Out of the 228 patients who received pharmacy discharge counseling, 18.9% were readmitted within 30 days of hospital discharge, which was similar to the readmission rate for high- and moderate-risk patients who did not receive counseling (18.8% and 18.9%, respectively). But, after stratification based on readmission risk, the moderate-risk, pharmacy-counseled group had a significantly lower readmission rate than the moderate-risk control group (3.8% vs. 18.9%; P=0.033). Overall, 915 pharmacist interventions were made, averaging 4 interventions per patient.
  
  
  CONCLUSIONS
  Pharmacy discharge counseling was associated with reduced 30-day readmission rates in those patients at moderate risk for readmission.
authors: Maryland Veterans Affairs Health System MedStar Union Memorial Hospital Pharmacy.
authors: Kimberly L
authors: KL
authors: Still
authors: Azizza K
authors: AK
authors: Davis
authors: Allison A
authors: AA
authors: Chilipko
authors: Aroonjit
authors: A
authors: Jenkosol
authors: Daryn K
authors: DK
authors: Norwood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital
keywords: AHSP = American Society of Health-System Pharmacists; AMI = Acute myocardial infarction; Centers for Medicare & Medicaid Services; DM = Diabetes mellitus; Discharge counseling; ED = Emergency department; HF = Heart failure; HTN = Hypertension; Internal medicine; MedPAC = Medicare Payment Advisory Commission; PCP = Primary care provider; PNA = Pneumonia; PPMI = Pharmacy Practice Model Initiative; Pharmacy; Readmission; Transitions of care