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Drug Reconciliation Program Cuts Hospital Readmission

CVS pharmacy sign

CVS pharmacy sign in Durham, North Carolina (Ildar Sagdejev, Wikimedia Commons)

7 July 2016. Consultations with pharmacists on medications when patients leave the hospital for home are shown to reduce the rate of readmission to the hospital by half. A study evaluating a medication reconciliation program, as these efforts are called, appears in the July issue of the journal Health Affairs (paid subscription required).

The study, conducted by the drug store chain CVS Health, aimed to document the impact of medication reconciliation initiatives on readmission rates to hospitals and health care costs overall. Medication reconciliation provides counseling to patients about their drugs as they are discharged from the hospital and return home. During this transition, patients change from the care of hospital clinicians to their personal doctors, often with new medications or changes in their previous prescriptions.

Medication reconciliation programs also aim to resolve any errors or discrepancies, such as omissions or duplication, that could lead to adverse drug events, as well as make sure patients fully understand their new prescriptions. The U.S. Agency for Healthcare Research and Quality says discrepancies in medications during this transition is one of the most common types of adverse events following hospital stays.

Hospitals have other incentives to reduce their readmission rates. The Affordable Care Act penalizes hospitals by reducing Medicare reimbursements if their readmission rates for heart attack, heart failure, and pneumonia within 30 days far exceed national averages. Kaiser Health News reported in August 2015 that after 4 years of these penalties, readmission rates declined in the U.S. overall, but 1 in 5 Medicare patients are still readmitted within 30 days, and nearly 2,600 hospitals in the U.S. were hit with fines.

The study evaluated a medication reconciliation program offered by a national health plan. In that program, pharmacists provided consultations to patients at home or over the telephone, based on their risk of readmission, as well as ongoing consultations by phone if requested. The pharmacists reviewed pre- and post-discharge medications lists, identified discrepancies or redundancies, highlighted any safety concerns, and provided instructions and support to patients on medication use and adherence.

The research team from CVS Health reviewed the records of 260 hospitalized patients from the health plan over a 5-month period, comparing participants in the medication reconciliation program to patients without additional support following their discharge from the hospital. The results show 11 percent of the patients in the medication reconciliation program were readmitted to the hospital within 30 days, compared to 22 percent of individuals not participating in the program, a reduction of half.

Overall health care costs for people in the medication reconciliation program were also lower. Total savings for people enrolled in the program were on average $1,300 less after taking part, which translates into a savings of $2.00 for each $1.00 spent on the program.

Troyen Brennan, chief medical officer for CVS Health notes in a company statement that, “the positive effects of the pharmacist consultation on reducing readmission rates and costs were similar whether the consultation was conducted via an in-home visit from a pharmacist or over the telephone when the intensity of the intervention was tailored to members’ risk.” He adds that the results, “demonstrate that there is an opportunity for payers to consider adopting programs that provide pharmacist support and counseling by phone as a cost-efficient way to help improve medication adherence and health outcomes for their vulnerable populations.”

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