Telehealth Pharmacist Approach to Comprehensive Medication Management in Post-Discharge High-Risk Patients: A Quality Improvement Initiative

Introduction:Clinical Pharmacist-led Comprehensive Medication Management (CMM) has the potential to mitigate medication errors during transitions in care, but current evidence is underdeveloped. The objective of this work was to assess the impact of optimized CMM services through a telehealth pharmacist clinic on hospital readmission and Emergency Department (ED) utilization rates.

Methods:A quality improvement study with patients discharged home from an urban, nonacademic Hospital in Westchester County, New York, receiving telehealth CMM was used. Participants included adult patients discharged home from an internal medicine unit considered high risk for preventable adverse medication errors based on comorbidities and prescribed medications. Eligible patients were offered to enroll in telehealth CMM visits with a clinical pharmacist immediately, 30 days, and 60 days post-discharge versus the current standard of care.

Results:Primary outcomes included the impact on 30- and 90-day readmission and ED visit rates. Secondary outcomes included quantifying the outcomes on patient engagement, enrollment, and volume resulting from the program’s process improvements. In this study, 3,060 patients were discharged from June 14, 2021, to May 10, 2022; 1,547 were eligible and offered CMM visits, and 889 completed enrollment (Treated). There was a 2.1% absolute difference in 30-day readmission rates between untreated and attempted (p = 0.07), and a 2.9% difference between the untreated and treated group (p = 0.04). Thirty-day ED utilization decreased by 1.6% between untreated and attempted (p = 0.3), and 3.5% between the untreated and treated (p = 0.03). There were four Plan-Do-Study-Act cycles in this program, in which the process improvements resulted in an overall average increase in patient volume, enrollment rates, and patient engagement for this QI initiative.

Conclusions:This study yielded significant reductions in readmission and ED utilization rates among treated patients, highlighting successful process improvements that improved patient engagement and the potential for enhancing care coordination in vulnerable populations.