Browsing by Subject "pharmacy"

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    Evaluation of a “Meds-to-Beds” program on 30-day hospital readmissions
    (ACCP, 2020-05) Zillich, Alan J.; Jaynes, Heather A.; Davis, Hannah B.; Lantaff, Wendy M.; Myers, Jaclyn; Perkins, Susan M.; Shan, Mu; Snyder, Margie E.; Biostatistics, School of Public Health
    Background Effective programs for transitional care from hospital to home are needed to improve patient outcomes. Purpose To evaluate readmissions among patients who received a medication discharge program compared with control patients who did not receive the program. Methods This was a retrospective, observational cohort study during a 1-year period in a medium-sized Midwestern health system. The “meds-to-beds” program consisted of a pharmacist and/or technician delivering patient's medications to bedside prior to discharge. When indicated, the pharmacist provided medication counseling, reviewed discharge medications, and provided an updated medication list to patients. The intervention cohort was defined as all hospitalized patients eligible for and opting into the “meds-to-beds” program. The control cohort was defined as hospitalized patients eligible for the program who did not opt-in to receive it. Data were collected through both a retrospective chart review and an administrative claims data warehouse. The primary outcome was defined as any 30-day readmissions. Secondary outcomes were defined as any preventable 30-day readmissions using the Agency for Healthcare Research and Quality's potentially avoidable hospitalization for ambulatory care sensitive conditions classification. Multivariable logistic regression models examined the odds of 30-day readmissions between the intervention and control groups. Results Data were collected for 500 intervention and 1591 control patients. Both groups were similar with respect to age, gender, race, co-morbid conditions, and previous health care utilization. In the multivariable model, all-cause readmissions within 30 days were not significantly different between the intervention and control groups (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.42-1.07, P = .09). The most common preventable readmissions were for pneumonia (43.2%), heart failure (18.9%), and dehydration (16.2%). In the multivariable model, patients in the intervention group were less likely to be readmitted for a preventable cause within 30-days than patients in the control group (OR = 0.49; 95% CI: 0.28-0.89, P = .02). Conclusion This “meds-to-beds” program was not associated with a significant reduction in 30-day all-cause readmissions but was associated with a reduction in 30-day preventable hospital readmissions.
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    Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment
    (Elsevier B.V., 2015-06-06) Norwood, Connor W.; Wright, Eric R.
    Background Pharmacists have shared responsibility to investigate the validity of controlled substance prescriptions (CSPs) that raise concerns, or red flags, and subsequently exercise their right to refuse to dispense a CSP if its validity cannot be verified. Improving access to clinical practice tools, such as prescription drug monitoring programs (PDMPs), may increase availability of a patient's drug history, which is critical to making informed clinical decisions about dispensing CSPs. Objectives The purpose of this study was to examine how integration and consistent use of a PDMP in pharmacy practice impacts pharmacists' dispensing practices related to CSPs. Methods A cross-sectional study examined pharmacists' knowledge and use of Indiana's (US State) PDMP (INSPECT) and dispensing practices of CSPs. Three outcome measures were analyzed using multiple logistic regression so as to examine the relationship between PDMP use and pharmacists' controlled substance dispensing behaviors. Results Pharmacists were 6.4 times more likely to change their dispensing practice to dispense fewer CSPs if they reported that INSPECT provides increased access to patient information. Pharmacists who always use INSPECT refused an average of 25 CSPs annually compared to an average of 7 refusals for pharmacists not using INSPECT. Pharmacists using INSEPCT consistently (at every visit) were 3.3 times more likely to refuse to dispense more CSPs than pharmacists who report never using INSPECT. Conclusions Integration of PDMPs in pharmacy practice may improve a pharmacist's ability to make informed clinical decisions and exercise sound professional judgment. Providing clinical practice tools to both prescribers and pharmacists is important to preventing drug diversion and prescription drug abuse. Future research should focus on understanding the barriers and challenges to successful integration of PDMPs in pharmacy practice.