title: Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial.
abstract: BACKGROUND
  Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal.
  
  
  OBJECTIVE
  The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge.
  
  
  METHODS
  Randomized, controlled trial with concealed allocation and blinded outcome assessors
  
  
  METHODS
  Two tertiary care academic medical centers
  
  
  METHODS
  Adults hospitalized with a diagnosis of ACS and/or ADHF.
  
  
  METHODS
  Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge
  
  
  METHODS
  The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported.
  
  
  RESULTS
  A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition.
  
  
  CONCLUSIONS
  A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.
authors.affiliation: Vanderbilt Center for Translational and Clinical Cardiovascular Research (VTRACC), Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Suite 300-A 2525 West End Avenue, Nashville, TN, 37232-8300, USA. susan.p.bell@vanderbilt.edu.|Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN, USA. susan.p.bell@vanderbilt.edu.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Bell
authors.affiliation: Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, TN, USA.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Goggins
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, TN, USA.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA.|Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center, Nashville, TN, USA.
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.affiliation: Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Dalal
authors.affiliation: Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Jacobson
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Rask
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.affiliation: National Patient Safety Foundation, Boston, MA, USA.
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.affiliation: Department of Pharmacy Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Labonville
authors.affiliation: Vanderbilt University, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Vanderbilt University, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Neal
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, TN, USA.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000628:therapy*; D000328:Adult; D000368:Aged; D003376:Counseling / Q000458:organization & administration; D005260:Female; D057220:Health Literacy; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000458:organization & administration; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010593:Pharmaceutical Services / Q000458:organization & administration*; D016037:Single-Blind Method; D012959:Socioeconomic Factors; D014481:United States
keywords: Acute coronary syndrome; Health literacy; Heart failure; Pharmacist; Readmissions