Hospital Discharges and Medication Management

When CMS began its focus on hospital readmissions several years ago, it provided an opportunity for people to construct a variety of programs designed to minimize returns to the hospital following discharge.  It appeared that issues with drug therapy were a factor in many readmissions, so several initiatives have targeted better medication therapy and adherence.  Research published in Health Affairs describes one of these programs, run by CVS.  (HA Article)   Medication problems are common following hospital discharges; patients often have new medications, and they may have to resume taking older ones.  Patients may be physically and mentally weakened and may need help from care-givers, who can also struggle to understand drug regimens.  Failure to precisely follow dosing instructions is common, as are side effects.  The intervention studied was sponsored by a commercial insurer and targeted members at high risk of readmission following a hospitalization.  Patients who met the criteria were contacted after discharge and asked if they would like to participate in the program, which included pharmacist counseling, either in the home or by phone.  Pharmacists provided personalized education and coaching and communicated with providers treating the patient regarding drug therapy issues.

The primary outcome was effect on readmissions and cost savings were analyzed as well.  A control group not participating in the intervention was constructed.  Patients in the control group were matched with those in the control arm and other adjustments were made.  Drug therapy problems were common, occurring in about two-thirds of all cases.  16% of the time there were drug-drug interactions, which can be very serious.  The primary result indicated that the intervention led to about a 50% reduction in readmissions.  Most importantly, for every one dollar that the intervention cost, it saved about $2, or almost $1350 per member.  The study indicates that medication therapy problems are common following a hospitalization and that a relatively simple intervention can not only identify and correct these problems, but reduces hospitalizations and spending.