Pharmacist calls to older adults with cognitive difficulties after discharge in a Tertiary Veterans Administration Medical Center: a quality improvement program.
OBJECTIVE
To evaluate the effect of the Pharmacological Intervention in Late Life (PILL) Service, which provides pharmacist telephone follow-up after discharge of older adults from the hospital, on postdischarge acute care utilization.


METHODS
Retrospective, secondary data analysis of a quality improvement project from 2010 to 2012.


METHODS
Tertiary Veterans Affairs hospital.


METHODS
Participants were inpatients aged 65 and older with delirium risk or prescribed a dementia medication (N=501, mean age 79.5±8.0; 98% male).


METHODS
PILL Service pharmacist telephone follow-up included a medication review and reconciliation within 5 days after hospital discharge. The time of the pharmacist call was examined in relation to the outcomes of emergency and urgent care encounters, readmissions, and mortality within 60 days.


RESULTS
The average number of discharge medications was 14.8±5.7 with 2.8±2.2 medication changes and 1.4±1.8 discrepancies between medication order and instruction. After adjustment for age, number of medication changes, and number of discrepancies, every additional 5 minutes of pharmacist call was associated with a 15% reduction in 60-day readmission (adjusted odds ratio (OR)=0.85, 95% confidence interval (95% CI)=0.75-0.97) but was not associated with emergency or urgent care encounters (adjusted OR=1.03, 95% CI=0.91-1.17) or mortality (adjusted OR=0.84, 95% CI=0.58-1.20).


CONCLUSIONS
Pharmacist-led medication review, reconciliation, and telephone calls after hospital discharge were associated with fewer 60-day hospital readmissions in this quality improvement program.
Department of Pharmacy, VA Boston Healthcare System, Boston, Massachusetts; Department of Clinical Pharmacy Practice, Northeastern University, Boston, Massachusetts.
Allison M
AM
Paquin
Marci
M
Salow
James L
JL
Rudolph
D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010593:Pharmaceutical Services; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
medication reconciliation; medication safety; transitions in care