Pharmacist-Provided Medication Management in Interdisciplinary Transitions in a Community Hospital (PMIT).
Medication management during transitions of care (TOC) impacts clinical outcomes. Published literature on TOC implementation is increasing, but data remains limited regarding the optimal role for the inpatient pharmacist, particularly in the community health setting.



To evaluate the impact of a dedicated inpatient TOC pharmacist on re-presentations following discharge.



This is a prospective study with historical control. All adult patients discharging home from study units were eligible. The TOC pharmacist (1) reviewed medication history and admission reconciliation, (2) met the patient/caregiver to assess barriers, (3) reviewed discharge reconciliation, (4) performed discharge education, and (5) communicated with next level of care. The primary outcome was 30 day re-presentation rate. Secondary outcomes included 60, 90, and 365 day re-presentation rates. IRB approval was obtained.



Three hundred and eighty four patients met inclusion criteria. When compared to 1,221 control patients, the intervention had an 11% absolute and 50.2% relative reduction in 30 day re-presentation rate (OR 0.43, 95% CI 0.30-0.61, NNT 9). Reductions in re-presentations at 60, 90 and 365 days remained statistically significant. Utilization avoidance was $786,347. For every $1 invested in pharmacist time, $12 was saved. The TOC pharmacist made a total of 904 interventions (mean 2.4 per patient).



This study provides new information from previous studies and represents the largest study with significant and sustained reductions in re-presentations. Integrating a pharmacist into an interdisciplinary team for medication management during TOC in a community health system is beneficial for patients and financially favorable for the institution.
Mission Hospital and UNC Eshelman School of Pharmacy, Asheville Campus; Asheville, NC, USA aubrie.rafferty@msj.org.
Aubrie
A
Rafferty
Mission Health System, Asheville, NC, USA.
Sheri
S
Denslow
Mission Hospital and UNC Eshelman School of Pharmacy, Asheville Campus; Asheville, NC, USA.
Elizabeth Landrum
EL
Michalets
D000328:Adult; D000368:Aged; D005260:Female; D006764:Hospitals, Community / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D059065:Medication Reconciliation / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D009657:North Carolina; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000592:standards; D011446:Prospective Studies
antiarrhythmics; arrhythmias; cardiology; clinical trials; meta-analysis