A Collaboration among Primary Care-based Clinical Pharmacists and Community-based Health Coaches

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Sorensen, Andrea ; Grotts, Jonathan F. ; Tseng, Chi-Hong ; Moreno, Gerardo ; Maranon, Richard ; Whitmire, Natalie ; Viramontes, Omar ; Atkins, Sandy ; Sefilyan, Ester ; Simmons, June W. ; Mangione, Carol M.
• Description:
  BACKGROUND/OBJECTIVE:
  
  Medication discrepancies and adverse drug events are common following hospital discharge. This study evaluates whether a collaboration between community-based health coaches and primary care-based pharmacists was associated with a reduction in inpatient utilization following hospitalization.
  
  DESIGN:
  
  Retrospective cohort study using propensity score matching.
  
  SETTING:
  
  Urban, academic medical center and surrounding community.
  
  PARTICIPANTS:
  
  Intervention patients (n=494) were adults aged 65 or older admitted to the UCLA Ronald Reagan Medical Center during the study period and who met study inclusion criteria. A matched-control group was comprised of patients with similar demographic and clinical characteristics who were admitted to the study site during the study period, but who received usual care (n=2,470). A Greedy Algorithm approach was used to conduct the propensity score match.
  
  INTERVENTION:
  
  Following acute hospitalization, a health coach conducted a home visit and transmitted all medication-related information to a primary care practice-based pharmacist. The pharmacist compared this information to the patient’s electronic medical record medication list and consulted with the patient’s primary care provider to optimize medication management.
  
  MEASUREMENTS:
  
  30-day readmissions (primary outcome); 60 and 90-day readmissions and 30-day emergency department (ED) visits (secondary outcomes) to UCLA Health.
  
  RESULTS:
  
  Among 494 patients who received the intervention, 307 (62.1%) were female with a mean age of 83.0 [IQR 76–90] years. Among 2,470 matched control patients, 1541 (62.4%) were female with a mean age of 82.7 [IQR 74.9–89.5] years. For the propensity score match, standardized mean differences were <0.1 for 23 out of 25 variables, indicating good balance. Patients who received this intervention had a significantly lower predicted probability of being readmitted within 30 days compared with matched-control patients (10.6% [CI 7.9–13.2] versus 21.4 % [19.8–23.0], p-value <0.001).
  
  CONCLUSION:
  
  A home visit conducted by a health coach combined with medication review by a primary care-based pharmacist may prevent subsequent inpatient utilization.
  
  
• Subjects:
  Article Care Transitions Clinical Pharmacists Home-bound Older Adults Hospital Readmissions Medication Management
• Source:
  J Am Geriatr Soc. 69(1):68-76
• Pubmed ID:
  33026662
• Pubmed Central ID:
  PMC8006864
• Document Type:
  Journal Article
• Funding:
  TL1TR001883/TR/NCATS NIH HHS/United States ; UL1TR001881/TR/NCATS NIH HHS/United States ; U18DP006140/ACL/ACL HHS/United States ; TL1 TR000121/TR/NCATS NIH HHS/United States ; P30 AG021684/AG/NIA NIH HHS/United States ; TL1 TR001883/TR/NCATS NIH HHS/United States ; P30AG021684/NIH/NIA/ ; UL1 TR001881/TR/NCATS NIH HHS/United States ; R18DK105464/DK/NIDDK NIH HHS/United States ; U18DP006140/CC/CDC HHS/United States ; TL1TR000121/TR/NCATS NIH HHS/United States ; R18 DK105464/DK/NIDDK NIH HHS/United States ; U18 DP006140/DP/NCCDPHP CDC HHS/United States
• Volume:
  69
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4bf20512802b43b7b271881dc2e2de119f7df41c2c1ed9e29222bca4662f4b76
• Download URL:
  https://stacks.cdc.gov/view/cdc/104632/cdc_104632_DS1.pdf
• File Type:
  [PDF - 589.10 KB ]