title: Impact of a discharge medication therapy management program in an extended care hospital.
abstract: OBJECTIVE
  To study the feasibility and effectiveness of a discharge medication therapy management program.
  
  
  METHODS
  Quasi-experimental pre-post study design.
  
  
  METHODS
  Thirty-six-bed hospital within an extended care hospital.
  
  
  METHODS
  All patients admitted to facility from January 2009 to December 2009 (control) and February 2010 to January 2011 (program).
  
  
  METHODS
  Pharmacist review of anticipated discharge following 18-20 days of stay, with suggested medication changes communicated to physicians via patient chart. Agreed changes were implemented on the next day.
  
  
  METHODS
  Patient readmissions within 30, 60, and 90 days into the hospital system. Medication interventions were quantified as to type.
  
  
  RESULTS
  During the control period, 432 patients were followed, and during the intervention period, 369 patients were followed, with similar lengths of stay. In the intervention period, 565 medication interventions were attempted on 216 patients, with an 85.3% acceptance rate. The major intervention was discontinuation of medications. Mean maintenance medications per patient decreased from 10.57 to 9.46 in the intervention group, and daily medication doses per patient decreased from 17.95 to 15.73 (P < 0.001). Readmission rates were lower at 30 and 60 days in the intervention group, with a 90-day overall decrease in system readmission rate from 51% to 39% (P < 0.001).
  
  
  CONCLUSIONS
  The discharge medication management program was successful in decreasing both number and type of discharge medications via pharmacist intervention. Overall, patient system readmission rates were also significantly decreased in the intervention period.
authors.affiliation: Methodist Extended Care Hospital, Memphis, Tennessee.
authors.forename: Lydia J
authors.initials: LJ
authors.lastname: Hutchison
authors.affiliation: Midwest Health, Hinsdale, Illinois.
authors.forename: George G
authors.initials: GG
authors.lastname: Mayzell
authors.affiliation: Methodist Extended Care Hospital.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Bailey
authors.affiliation: Methodist University Hospital, Memphis.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Broyles
mesh_terms: D005240:Feasibility Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D054539:Medication Therapy Management / Q000458:organization & administration*; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010865:Pilot Projects; D012866:Skilled Nursing Facilities / Q000458:organization & administration; D013997:Time Factors
keywords: Discharge; Hospital; Intervention; MECH = Methodist Extended Care Hospital; MTM = Medication therapy management; Pharmacist; Readmission rates