The Rural PILL Program: A Postdischarge Telepharmacy Intervention for Rural Veterans.
To evaluate the efficacy of the Rural Pharmacological Intervention in Late Life (PILL) program, a quality improvement initiative in which a Boston-based pharmacist provided postdischarge telepharmacy care to veterans from rural Maine.



Using an automated screening tool, we identified 100 veterans aged 65 and older who had an acute care admission to VA medical centers in Boston or Maine and were at risk of problems with medication management. The PILL pharmacist called patients the week after hospital discharge to reconcile medications, assess adherence, and identify potentially inappropriate drugs. The pharmacist worked with each veteran's family and providers to resolve problems and increase support. To determine whether the intervention decreased acute care admissions, rehospitalizations, or deaths, we matched 1 unique control to each PILL patient by age, hospital location, length of stay, admitting service, and reason for admission. Logistic regression was performed to determine the OR and 95% CI of the outcomes.



Patients were discharged on an average of 16 medications and with 4.4 medication changes. Overall, 61% of patients had clerical errors in the discharge summary, and potential clinical concerns were identified in over 75%. Veterans who received the intervention were 70% less likely than controls to have an acute care visit at 30 days postdischarge (7 vs 20 patients; OR = 0.30; 95% CI: 0.12-0.75). There was no difference in rates of hospital readmission or mortality.



This pharmacist-led phone-based program was effective in decreasing acute care utilization within 30 days after hospital discharge.
Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.|Division of Pharmacy, VA Boston Healthcare System, Boston, Massachusetts.
Katherine E
KE
Rebello
Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.
Jeffrey
J
Gosian
Division of Pharmacy, Salem VA Medical Center, Salem, Virginia.|University of Connecticut School of Pharmacy, Storrs, Connecticut.
Marci
M
Salow
Division of Pharmacy, VA Togus Healthcare System, Togus, Maine.
Pamela
P
Sweeney
Center of Innovation in Long Term Services and Supports, Providence VAMC, Providence, Rhode Island.|Warren Alpert School of Medicine, Brown University, Providence, Rhode Island.
James L
JL
Rudolph
Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
Jane A
JA
Driver
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008281:Maine; D008297:Male; D010351:Patient Discharge / Q000592:standards*; D010593:Pharmaceutical Services / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000639:trends; D024382:Professional Role; D015397:Program Evaluation / Q000379:methods; D058996:Quality Improvement; D012424:Rural Population / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods* / Q000592:standards; D014728:Veterans / Q000706:statistics & numerical data
access to care; geriatrics; medical care; pharmacy; program evaluation