Pharmacist calls to older adults with cognitive difficulties after discharge in a Tertiary Veterans Administration Medical Center: a quality improvement program.

OBJECTIVES: To evaluate the effect of the Pharmacological Intervention in Late Life (PILL) Service, which provides pharmacist telephone follow-up after discharge of older adults from the hospital, on postdischarge acute care utilization.
DESIGN: Retrospective, secondary data analysis of a quality improvement project from 2010 to 2012.
SETTING: Tertiary Veterans Affairs hospital. PARTICIPANTS: Participants were inpatients aged 65 and older with delirium risk or prescribed a dementia medication (N=501, mean age 79.5±8.0; 98% male). MEASUREMENTS: PILL Service pharmacist telephone follow-up included a medication review and reconciliation within 5 days after hospital discharge. The time of the pharmacist call was examined in relation to the outcomes of emergency and urgent care encounters, readmissions, and mortality within 60 days.
RESULTS: The average number of discharge medications was 14.8±5.7 with 2.8±2.2 medication changes and 1.4±1.8 discrepancies between medication order and instruction. After adjustment for age, number of medication changes, and number of discrepancies, every additional 5 minutes of pharmacist call was associated with a 15% reduction in 60-day readmission (adjusted odds ratio (OR)=0.85, 95% confidence interval (95% CI)=0.75-0.97) but was not associated with emergency or urgent care encounters (adjusted OR=1.03, 95% CI=0.91-1.17) or mortality (adjusted OR=0.84, 95% CI=0.58-1.20).
CONCLUSION: Pharmacist-led medication review, reconciliation, and telephone calls after hospital discharge were associated with fewer 60-day hospital readmissions in this quality improvement program. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.