Clinical Outcomes of a Home-Based Medication Reconciliation Program After Discharge from a Skilled Nursing Facility
- 1 April 2008
- journal article
- research article
- Published by Wiley in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
- Vol. 28 (4), 444-452
- https://doi.org/10.1592/phco.28.4.444
Abstract
To assess the impact of a pilot pharmacist-managed medication reconciliation program on mortality and use of health care services in patients discharged to home from a skilled nursing facility (SNF).Quasi-experimental, controlled trial.Health maintenance organization (HMO).Five hundred twenty-one HMO members.Patients were assigned to the medication reconciliation program (113 patients) or to the usual care control group (408 patients) after discharge to home from an SNF. Assignment to the medication reconciliation group or to the control group was based on provider submission of a discharge summary within 0-48 hours of discharge or more than 48 hours after discharge, respectively.Integrated electronic medical and pharmacy data and multivariate analyses were used to assess the medication reconciliation program with regard to its impact on postdischarge mortality, rehospitalization, and ambulatory clinic and emergency department visits. Compared with usual care during the 60 days after discharge from the SNF, patients who received the medication reconciliation intervention had an adjusted 78% reduction in the risk of death (adjusted hazard ratio 0.22, 95% confidence interval [CI] 0.06-0.88) and a trend toward an increased rate of ambulatory care visits (adjusted incidence risk ratio 1.17, 95% CI 0.99-1.37). No significant differences were noted in adjusted risks of an emergency department visit and rehospitalization (p>0.05) between the medication reconciliation and usual care groups.Our data support the hypothesis that a formal medication reconciliation process, with its increased coordination of information between health care providers and patients, can decrease mortality after discharge from an SNF. Our findings support the role of medication reconciliation as an integral step in the transitional care process and interests of health care accrediting agencies, such as the Joint Commission, that have included medication reconciliation as an important initiative.Keywords
This publication has 16 references indexed in Scilit:
- Role of Pharmacist Counseling in Preventing Adverse Drug Events After HospitalizationArchives of Internal Medicine, 2006
- Does home based medication review keep older people out of hospital? The HOMER randomised controlled trialBMJ, 2005
- Common comorbidity scales were similar in their ability to predict health care costs and mortalityJournal of Clinical Epidemiology, 2004
- Consistency of performance ranking of comorbidity adjustment scores in canadian and U.S. utilization dataJournal of General Internal Medicine, 2004
- Gaps in the care of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary diseaseCMAJ : Canadian Medical Association Journal, 2004
- A transitional care service for elderly chronic disease patients at risk of readmissionAustralian Health Review, 2004
- Effects of a multidisciplinary, home-based intervention on planned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled studyThe Lancet, 1999
- Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment planArchives of Internal Medicine, 1997
- A Chronic Disease Score with Empirically Derived WeightsMedical Care, 1995
- A chronic disease score from automated pharmacy dataJournal of Clinical Epidemiology, 1992