Healthcare News & Insights

In-home pharmacist medication management cuts readmissions

Hospitals must continue to do their best to stop readmissions in patients. This includes trying more innovative approaches when following up with patients post-discharge, such as bringing providers to their homes to help them understand their medications. 

ThinkstockPhotos-507211936Recent research has shown that house calls from providers reduce the risk of readmission in patients who’ve had heart surgery.

Now, the results of another study show that hospitals can take it a step further and have pharmacists visit patients after discharge.

According to an article from Managed Healthcare Executive, a hospital in Minnesota participated in a pilot project designed to help frail, low-income elderly patients avoid being admitted to the hospital again.

Regions Hospital in St. Paul offered these patients the chance to participate in its medication therapy management (MTM) home visit program. Those enrolled in the program were on multiple medications for serious chronic illnesses, and had difficulty leaving their homes.

The hospital administered the program through HealthPartners, a consumer-governed nonprofit healthcare system and insurer based in Minnesota. HealthPartners brings together a number of healthcare resources to serve patients, including home health agencies, clinics, hospitals and geriatric specialists.

Clinical pharmacists affiliated with HealthPartners visited patients in their homes within a week of their discharge from Regions Hospital.

According to a fact sheet about the program, the pharmacists:

  • reviewed every medication each patient was taking, keeping an eye out for problems
  • ensured patients understood how to take their medication, and
  • evaluated the patient’s home for any risks that could cause readmission (e.g., fall risks).

After the initial home visit, pharmacists made several follow-up efforts to keep in touch with patients, either in person or over the phone.

Kept patients healthy

Overall, the MTM home visit program was successful with reducing preventable readmissions.

Only 6% of patients who received a home visit were readmitted to Regions Hospital within 30 days, compared to a 16% readmissions rate for those who didn’t receive any in-home follow-up medication management services.

Common medication issues

Through the MTM home visit program, pharmacists identified four medication problems that were common for many patients after they’ve left the hospital:

  1. A medication is no longer needed. Patients were often taking medications they were prescribed years earlier out of habit, even if they no longer had symptoms of the original illness. This was most commonly seen with heartburn medication. Taking these drugs long term for no reason increased patients’ risk of harm. Upon discussion with the rest of the care team, these medications were discontinued.
  2. A drug isn’t being taken as prescribed. Often, patients leave the hospital with a list of new medications different from the ones they’re used to. So they can get confused about how to take them correctly at home. To help them adhere to their new drug regimen, pharmacists laid out the specifics for how and when they should take their medications.
  3. A new medication is needed. Because these patients had multiple chronic conditions to manage, occasionally a medical issue would slip through the cracks, and a medication wouldn’t be prescribed that could improve their health. Pharmacists closed these gaps.
  4. The dosage for a medication is too high. Sometimes, patients would take the same dose of a medication for years without being evaluated by a provider to see if the amount was still appropriate given their age, general health or any other health conditions that may have developed over time. These changes made high doses of medications unnecessary for patients in some instances.

Helping patients manage meds

Working with community-based health organizations that might be able to offer patients similar in-home medication-management services is an excellent idea.

But you may not have the connections or resources to implement a pharmacist-at-home program in your hospital. However, you can still use some of the principles of the HealthPartners MTM home visit program to help patients take their medication as prescribed.

With the above-mentioned problems patients have with their medication in mind, it’s smart to have clinical staff review all of a patient’s prescriptions in detail before discharge, giving patients and family members the opportunity to ask questions and get more details about the medications.

That way, you can nip common problems in the bud before they contribute to a patient’s readmission.

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