Pharmacists and transitions of care from emergency department to home

• Published in: The American journal of managed care 2023-12, Vol.29 (12), p.715-719
• Main Authors: Dunn, Terry E, Desai, Kalpesh J, Krajewski, Michael P, Jacobs, David M, Lu, Chi-Hua, Paul, Sucharita, Paladino, Joseph A
• Format: Article
• Language: English
• Subjects: Ambulatory care; Drug stores; Emergency medical care; Emergency Service, Hospital; Health services utilization; Hospitalization; Humans; Hypothesis testing; Intervention; Outreach services; Patient admissions; Patient compliance; Patient Discharge; Patient Readmission; Performance evaluation; Pharmacists; Reconciliation
• ISSN: 1088-0224; 1936-2692; 1936-2692
• DOI: 10.37765/ajmc.2023.89473

To determine the impact of a pharmacist-led telephone outreach program among patients discharged from the emergency department (ED) to home. We conducted a randomized controlled study from February to November 2019 at a tertiary care academic medical center. At ED discharge, participants were randomly assigned to usual care (controls) or usual care plus the pharmacist's review (intervention group). Eligible individuals included those being discharged from the ED to home with 8 or more medications. A pharmacist telephoned patients in the intervention group within 48 to 96 hours after ED discharge. The medications in the patient's record from the ED were compared with what the patient was taking at home. Discrepancies were communicated to the primary provider via fax or telephone. The primary outcome was overall health care utilization including unplanned hospital readmissions or ED visits within 30 days of discharge. The effect of the intervention on the number of acute events was analyzed using a Poisson regression model adjusting for relevant baseline characteristics. Of 90 eligible participants, 45 patients each were in the intervention and control groups. A total of 26 patients (58%) in the intervention group were reached, and 56 interventions were provided by the pharmacists. There was no significant difference between groups for overall health care utilization (adjusted risk ratio [aRR], 1.01; 95% CI, 0.50-2.06; P = .96), hospitalizations (aRR, 0.20; 95% CI, 0.02-2.18; P = .19), and ED visits (aRR, 1.24; 95% CI, 0.56-2.79; P = .59). A pharmacist-led telephone outreach program conducted after ED discharge was not associated with a change in health care utilization.