Preventing Hospital Readmission of Heart Failure Patients

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Pharmacists and managers are increasingly involved with interdisciplinary programs aimed to improve patient outcomes and decrease costs. Pharmacists are increasingly involved with, or actually spearhead the creation of such programs. There has been much attention on reducing hospital readmissions. This comes especially in light of hospital organizations being financially penalized by payers for discharging patients too sickly and too quickly and only to see them readmitted in a short period of time.

McKinley et al examine a pharmacist-led intervention aimed to reduce hospital readmission among African-American males with heart failure.1 The authors describe the problematic, clinically serious, and costly nature of heart failure (HF). HF is responsible for more 30-day readmissions than any other condition. Minorities, particularly African American males (AAM), are at much higher risk for readmission than the general population. In this study, demographic, social, and clinical data were collected from the electronic medical records of 132 AAM patients (control and intervention) admitted with a primary or secondary admission diagnosis of HF. Both groups received guideline-directed therapy for HF. Additionally, the intervention group received a pharmacist-led intervention that included active education and demonstration of lifestyle behavioral and disease management techniques. Data collected from these patients were used to validate a predictive model to evaluate the impact of the pharmacist-led intervention and identify predictors of readmission. Results revealed significantly fewer patients in the intervention group readmitted as compared to the control group (11.5% vs. 42.9%). The model also identified other risk variables related to diet, age, social support, self-efficacy, and others.

This is not the first nor will it be the last study to demonstrate effectiveness of pharmacist-led interventions. The study would have been that much better if it evaluated cost-effectiveness, which indeed was likely favorable given relatively incremental amounts of pharmacist time involved and momentous differences in readmission rates. Pharmacy managers can glean a number of things from this study, not only the fact that pharmacist-led interventions can be effective and save organizations considerable monies or provide new job opportunities and revenue streams. It’s important to examine how services can be targeted for specific populations perhaps in greatest need rather than trying to develop services for “everyone” including those without unmet needs. It also suggests that service outcomes will be optimized by considering a constellation of factors besides the service itself, such as social support and patient self-efficacy, so that the interventions can be further tailored and designed for success.

Additional information about Value-Added Services as a Component of Enhancing Pharmacists’ Roles in Public Health can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1McKinley D, Move-Dickinson P, Davis S, Akil A. Impact of a pharmacist-led intervention on 30-day readmission and assessment of factors predictive of readmission in African-American men with heart failure. Am J Mens Health. 2018;  Nov 28:1557988318814295. doi: 10.1177/1557988318814295

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Go to the profile of Shane Desselle
2 months ago

What needs to go into the planning to design services for particular populations rather than their design for “everyone”?