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
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https://doi.org/10.1177/0018578717715355
DOI: 10.1177/0018578717715355
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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
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