Sherry K Milfred-LaForest1, Julie A Gee2, Adam M Pugacz3, Ileana L Piña4, Danielle M Hoover5, Robert C Wenzell6, Aubrey Felton6, Eric Guttenberg6, Jose Ortiz7. 1. Department of Pharmacy, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States. Electronic address: Sharon.Laforest@va.gov. 2. Division of Cardiology, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States. 3. National Institutes of Health Clinical Center, Pharmacy Department, Bethesda, MD, United States. 4. Albert Einstein College of Medicine, Division of Cardiology, Montefiore-Einstein Medical Center, Bronx, NY, United States. 5. Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States. 6. Department of Pharmacy, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States. 7. Division of Cardiology, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Abstract
OBJECTIVE: To perform a pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients. BACKGROUND: Transitions of care in HF should include: medication reconciliation, multidisciplinary care, early post-discharge follow-up, and prompt intervention on HF signs and symptoms. We hypothesized that combining these elements with optimization of medications would impact outcomes. METHODS: In the SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC), patients were seen by a clinical pharmacist trained in HF. The pharmacist performed medication reconciliation, a basic physical exam, and a HF symptom history. Medications were adjusted by the clinical pharmacist or medical provider. Data were retrospectively collected for a quality improvement evaluation of this novel clinic on medication discrepancies, medications optimized, and 30-day readmissions. Descriptive statistics and paired t-tests were used for medication doses. RESULTS: All patients (n=135) had a diagnosis of HF, 59% were recently discharged. The mean time from discharge to the clinic appointment was 10±6days, and the 30day all-cause readmission rate was 9%. Medication discrepancies were detected in 53% of patients. Medications were optimized in 70%, most frequently beta blockers, ace inhibitors, and diuretics. In patients with an ejection fraction ≤40%, significantly higher doses of beta blockers and ace inhibitors were prescribed after the clinic visit. CONCLUSION: The HF MRTCC identified and corrected numerous medication discrepancies, up-titrated medications, and was associated with a 30-day readmission rate of 9%. These encouraging pilot results are hypothesis-generating and warrant further controlled trials. Published by Elsevier Inc.
OBJECTIVE: To perform a pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients. BACKGROUND: Transitions of care in HF should include: medication reconciliation, multidisciplinary care, early post-discharge follow-up, and prompt intervention on HF signs and symptoms. We hypothesized that combining these elements with optimization of medications would impact outcomes. METHODS: In the SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC), patients were seen by a clinical pharmacist trained in HF. The pharmacist performed medication reconciliation, a basic physical exam, and a HF symptom history. Medications were adjusted by the clinical pharmacist or medical provider. Data were retrospectively collected for a quality improvement evaluation of this novel clinic on medication discrepancies, medications optimized, and 30-day readmissions. Descriptive statistics and paired t-tests were used for medication doses. RESULTS: All patients (n=135) had a diagnosis of HF, 59% were recently discharged. The mean time from discharge to the clinic appointment was 10±6days, and the 30day all-cause readmission rate was 9%. Medication discrepancies were detected in 53% of patients. Medications were optimized in 70%, most frequently beta blockers, ace inhibitors, and diuretics. In patients with an ejection fraction ≤40%, significantly higher doses of beta blockers and ace inhibitors were prescribed after the clinic visit. CONCLUSION: The HF MRTCC identified and corrected numerous medication discrepancies, up-titrated medications, and was associated with a 30-day readmission rate of 9%. These encouraging pilot results are hypothesis-generating and warrant further controlled trials. Published by Elsevier Inc.
Authors: Lisa B VanWagner; Elisa Gordon; Lindsay Adamski; Megan Kosirog; Amna Daud; Daniel J Finn; Donald M Lloyd-Jones; Jane L Holl Journal: Liver Transpl Date: 2021-05 Impact factor: 5.799