Pharmacist interventions and health care outcomes in a novel heart failure medication adherence clinic

Purpose: Medication and lifestyle nonadherence is a common cause for rehospitalizations in heart failure (HF) patients. Patients who receive post-discharge education and support from a pharmacist have less re-hospitalizations and shorter lengths of stay. Our institution recently implemented a novel medication adherence clinic (MAC) aimed at improving transitions of care for HF patients. Our primary aims were to evaluate: 1) pharmacist interventions/activities 2) patient perceptions of pharmacist guidance 3) 30-day readmission rate.

Methods: Electronic medical record documentation was retrospectively reviewed to identify drug or disease related problems (DRPs) and subsequent pharmacist interventions (classified using the PCNE V6.2 modified DRP classification tool). Patient perception of pharmacy was prospectively assessed, against a control group using a pre and post-intervention survey (Purdue Pharmacist Directive Guidance Scale).  Participants were recruited via an electronic inpatient HF list.  Residents of long-term care facilities, patients admitted for hospice care, and those with severe communication deficits were excluded from the prospective phase.  Health care outcomes were evaluated retrospectively by comparing readmission rates of the clinic patients to control patients and historical institutional data.    

Results: We reviewed 16 MAC visits.  A total of 83 DRPs were identified, (average 5±2 DRPs per visit).  Thirty-six percent of DRPs were information/knowledge-based. Reasons for medication and diet nonadherence were multi-factorial and included poor care transitions, poor health literacy, and insufficient prescription taking skills. There were 223 interventions documented, (average 14±2 per visit). The majority of interventions were made in response to a patient’s lack of knowledge or information (49%). The readmission rate at 30 days was 31% (intervention group) versus 50% (control group), which was higher than the 2011 hospital average (27.4%).  

Conclusion: Pharmacists can make impactful interventions to improve adherence, increase disease state/medication knowledge and reduce 30 day readmission rates.  Pharmacists are also poised to prevent adverse events through identification of post-discharge medication discrepancies.