Hospital Pharmacy - May 2017 - 348

715355
research-article2017

HPXXXX10.1177/0018578717715355Hospital PharmacyAniemeke et al.

Article

Clinical Pharmacy Discharge Counseling
Service and the Impact on Readmission
Rates in High-Risk Patients

Hospital Pharmacy
2017, Vol. 52(5) 348-352
© The Author(s) 2017
Reprints and permissions:
sagepub.com/journalsPermissions.nav
https://doi.org/10.1177/0018578717715355
DOI: 10.1177/0018578717715355
journals.sagepub.com/home/hpx

Emmanuel Aniemeke1, Barrett Crowther2,3,4,
Stephanie Younts2,3,4, Darrel Hughes2,3,4,
and Crystal Franco-Martinez2,3,4

Abstract
Background: A number of patient safety and transition of care initiatives have highlighted the benefits of incorporating a
clinical pharmacist in the discharge medication process. Numerous studies have identified the prominent and consequential
role of medication therapy errors occurring at hospital discharge. Objective: The objective of this study was to evaluate
the effects of a discharge medication counseling service on readmission rates, emergency department (ED) visits, and days to
first readmission or ED visit in patients deemed high risk for hospital readmission. Methods: A retrospective chart review
was conducted from October 2014 to December 2014 in adult patients admitted to a general medicine unit and identified
as being at high risk for readmission. Endpoints were compared between patients who received discharge counseling (study
group) and those who did not (control group). Results: Eighty-nine high-risk patient charts were reviewed. Forty-four
patients were in the study group and 45 patients were in the control group. There were no differences between the baseline
characteristics of both groups. There were no differences between the study and control groups in 30-day readmission
rates (18.2% vs 26.7%; P = .45) and in 30-day ED visits (4.6% vs 11.1%; P = .43). The number of days to first readmission or
ED visit between the study and control groups was 22 versus 12 (P = .26). Conclusion: Although no statistical difference
was found between groups in this study, integration of a clinical pharmacist as part of an interdisciplinary approach in the
discharge medication process resulted in numerical improvements in outcomes. Additional investigation is warranted to
further highlight the potential benefits of this service.
Keywords
discharge counseling, hospital readmissions, pharmacist
Recent endeavors by the US health care system to reduce
hospital readmissions have gained widespread attention due
to implications on hospital reimbursement. Emphasis placed
on reducing unnecessary hospital-related costs by the Patient
Protection and Affordable Care Act has resulted in a focus
on readmission rates as a key outcome measure for health
systems.1-3 Studies show that 1 in 5 hospital discharges result
in a readmission, indicating that more resources should be
focused on the coordination of a comprehensive discharge
planning process and postdischarge care planning.4,5
The need to improve health care quality and outcomes has
led to increased attention and support for structured discharge
planning processes. Numerous patient safety and transition of
care initiatives have highlighted the benefits of incorporating
a clinical pharmacist into the discharge process.1,2,3,5 Recent
literature has proven that pharmacists have the ability to play
a vital role in this process by coordinating discharge medications and patient education. A prospective study published in
2013 by Pal and colleagues2 demonstrated a 9.2% decrease

(P = .006) in 30-day readmission rates in patients who
received medication reconciliation and counseling by a pharmacist versus a comparator group receiving usual care. An
observation study conducted by Anderegg and colleagues5 in
2014 showed a 5.5% decrease in 30-day readmission rates (P
= .042) and a nonsignificant decrease in the 30-day rate of
return to the emergency department (ED; 3.4%; P = .098)
after implementation of a pharmacy practice model that
included medication reconciliation and discharge education
1

Select Specialty Hospital, San Antonio, TX, USA
University Health System, San Antonio, TX, USA
3
The University of Texas at Austin, USA
4
The University of Texas Health Science Center at San Antonio, USA
2

Corresponding Author:
Crystal Franco-Martinez, Anticoagulation Clinical Pharmacist, Department
of Pharmacy, University Health System, The University of Texas at Austin
College of Pharmacy, 4502 Medical Drive, San Antonio, TX 78229, USA.
Email: ana.franco-martinez@uhs-sa.com


https://us.sagepub.com/en-us/journals-permissions http://journals.sagepub.com/doi/10.1177/0018578717715355 http://journals.sagepub.com/home/hpx

Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
Hospital Pharmacy - May 2017 - 383
Hospital Pharmacy - May 2017 - 384
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2019
http://www.nxtbook.com/nxtbooks/sage/fai_201909
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_july2019
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2019
http://www.nxtbook.com/nxtbooks/sage/canadianpharmacistsjournal_05062019
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2019
http://www.nxtbook.com/nxtbooks/sage/sri_supplement_201903
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2019
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2018
http://www.nxtbook.com/nxtbooks/sage/tec_20180810
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2018
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2018
http://www.nxtbook.com/nxtbooks/sage/fai_201807
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2018
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2018
http://www.nxtbook.com/nxtbooks/sage/sri_supplement_201803
http://www.nxtbook.com/nxtbooks/sage/slas_discovery_201712
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2018
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_november2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_september2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2017
http://www.nxtbook.com/nxtbooks/sage/fai_supplement_201709
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_may2017
http://www.nxtbook.com/nxtbooks/sage/fai_201706
http://www.nxtbook.com/nxtbooks/sage/fai_201607
http://www.nxtbookMEDIA.com