Impact of Pharmacist and Physician Collaborations in Primary Care on Reducing readmission to Hospital: A Systematic Review and Meta-analysis

Impact of Pharmacist and Physician Collaborations in Primary Care on Reducing readmission to Hospital: A Systematic Review and Meta-analysis
Sandra Leo, PharmD, Mille Lacs Health System

Background: Medication changes that occur during hospital admission for those with multiple chronic conditions often lead to medication discrepancies that contribute to hospital readmission rates. Patients with discrepancies are twice as likely to be readmitted to the hospital within 30 days of discharge than those without discrepancies. Previous meta-analyses have shown that hospital-based pharmacist medication reconciliation at discharge is effective for reducing hospital readmission. However, data is limited regarding the effect of pharmacist-led interventions in the primary care setting following hospital discharge.

Objective: This meta-analysis aimed to study whether pharmacist-led interventions and primary care provider (PCP) communication following hospital discharge reduces hospital readmission, as well as to describe and explore differences in the type of these interventions.

Study Design: Investigators performed a search of PubMed, EMBASE, The Cochrane Central Register of Controlled Trials, CINAHL and Web of Science to identify studies that described pharmacist-led interventions in patients transitioning from the hospital to community care. Trials were included if the participants were adult patients recently hospitalized, the pharmacist was the main contributor to an intervention in post-discharge care, at least part of the intervention occurred after discharge, and some communication occurred between the pharmacist and the patient’s PCP. All studies included an all-cause hospital readmission at any time during the study period, which was the primary endpoint. Secondary endpoints included the proportion of patients who had at least one readmission at 30 days, 90 days, or 6 months after discharge and incidence of all readmissions over the stated study period.

Results: The search yielded 37 studies which included sufficient data for inclusion to either primary and/or secondary outcomes. Pharmacist intervention demonstrated a reduction in the proportion of patients with at least one hospital readmission compared to controls during the study period (RR 0.87 [95% CI 0.79 – 0.97], P=0.01). Pharmacist intervention also demonstrated a reduction in the proportion of patients with hospital readmission at 30 days (RR 0.78 [95% CI 0.67 – 0.92]). However, no difference was shown at 90 days (RR 0.90 [95% CI 0.78 – 1.05]) or 6 months (RR 0.94 [95% CI 0.83 – 1.07]). Subgroup analyses showed pharmacist intervention reduced the proportion of patients with a hospital readmission when the intervention included a comprehensive medication review (RR 0.86 [95% CI 0.77-0.96]) and when the PCP communication was direct via telephone or face-to-face (RR 0.66 [95% CI 0.47 - 0.93], but not when the intervention was of a single component such as adherence alone (RR 0.96 [95% CI 0.68 - 1.36]) or when the PCP communication was indirect via fax or email (RR 0.89 [95% CI 0.75 - 1.05]).

Conclusions: This study shows that pharmacist intervention and communication with the PCP following discharge results in a 13% reduction in hospital readmissions, although the significantly reduced risk seems to be confined to the initial 30 days following hospital discharge. Benefits of pharmacist intervention are most effective when communication occurs via direct means, as well as when the intervention provides more comprehensive medication assessment. One limitation of this study was that the results were only statistically significant when stratified by type of studies; the included non-randomized control trials (RCT) showed a risk reduction in favor of pharmacist intervention while the RCTs did not. Another limitation was the moderate level of heterogeneity with regards to the primary outcome of hospital readmission at any time, as well as significant heterogeneity to a substantial degree in regards to the secondary outcome of total readmission incidence.
Key Point: Pharmacist interventions that involve communication with PCP following patients’ hospital discharge may help to reduce readmission rates at 30 days. Direct communication and comprehensive interventions are likely the most effective methodology for reducing readmission risk.

 

Reference

  1. Foot H, Scott I, Sturman N, et al. Impact of pharmacist and physician collaborations in primary care on reducing readmission to hospital: A systematic review and meta-analysis . Res Social Adm Pharm. 2021:doi: 10.1016/j.sapharm.2021.07.015.