Effect of Pharmacist Clinic Visits on 30-Day Heart Failure Readmission Rates at a County Hospital

Abstract

Purpose: This study evaluated the comparative effectiveness of different pharmacist visit types on reducing readmission rates. Method: A single-center, retrospective cohort study was conducted from January 2015 to July 2017. Patients were 18 years or older with an index heart failure (HF) exacerbation admission. Upon hospital discharge, patients were seen in clinic by a clinical pharmacy specialist (CPS) with collaborative practice agreement (CPA) (High Intensity Bundle), medication therapy management (MTM) pharmacist without CPA (Low Intensity Bundle), or no pharmacist (Standard of Care [SOC]). The primary outcome was 30-day all-cause readmission rate. Secondary outcomes included rate of 30-day HF readmissions and average number of days until readmission in those who were readmitted. Results: Totally, 98 patients were included in the final analysis (35 High Intensity Bundle, 28 Low Intensity Bundle, and 35 SOC). The primary outcome of all-cause readmissions was lower in both the pharmacist groups compared with SOC (CPS 8.6% [3/35] vs SOC 25.7% [9/35], P = 0.046 and MTM 7.1% [2/28] vs SOC 25.7% [9/35], P = 0.057). Incremental differences were seen between visit types for the secondary outcome of 30-day HF readmissions (CPS 2.9% vs MTM 7.1% vs SOC 17.1%, P = 0.039). The average number of days until readmission was longer in the CPS versus the MTM and SOC (26.7 days vs 12.5 days vs 14.1 days, respectively). Conclusion: Post-hospital discharge pharmacist visits were associated with lower 30-day all-cause readmission. In particular, clinic visits with a Higher Intensity Bundle may be more effective in reducing HF readmissions. These exploratory findings warrant further investigation.