The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization

• DOI: 10.1016/j.cct.2021.106419
• Publication Date: 2021-04-28T17:47:35Z
• Authors: Joshua M. Pevnick; Michelle S. Keller; Korey A. Kennelty; Teryl K. Nuckols; EunJi Michelle Ko; Kallie Amer; Laura Anderson; Christine Armbruster; Nicole Conti; John Fanikos; James Guan; Emmanuel Knight; Donna W. Leang; Ruby Llamas-Sandoval; Lina Matta; Dylan Moriarty; Logan T. Murry; Anne Marie Muske; An T. Nguyen; Emily Phung; Olga Rosen; Sonja L. Rosen; Audrienne Salandanan; Rita Shane; Jeffrey L. Schnipper
• Keywords: Comparative Effectiveness Research; Biomedical and clinical sciences; Clinical Trials and Supportive Activities; 8.1 Organisation and delivery of services; Nursing; Adverse drug events; Pharmacists; Medical and Health Sciences; Patient Readmission; 03 medical and health sciences; Medication Reconciliation; 0302 clinical medicine; Clinical Research; Health Services and Systems; Health Sciences; Humans; Medication management; General Clinical Medicine; Aged; 360; Health sciences; Transitional Care; Health Services; Patient Discharge; 3. Good health; Hospitalization; Good Health and Well Being; Readmissions; Geriatrics; Pharmacist; Female; Patient Safety; Generic health relevance; Public Health; Health and social care services research

Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals.The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission.If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs.ClinicalTrials.gov Identifier: NCT04071951.