Does interprofessional medication reconciliation from admission to discharge reduce post-discharge patient emergency department visits and hospital readmissions?

Purpose: To evaluate the impact of integrated interprofessional (pharmacist-prescriber) medication reconciliation on patient emergency department visits and hospital readmissions.

Methods: The setting for this retrospective, observational cohort study was two tertiary-care teaching hospitals.  Patient records were obtained from hospital administrative databases.  All hospitalized patients who were discharged by General Internal Medicine (GIM), Cardiology, and Multi-Organ Transplant services during the selected time periods were examined.   The intervention group (patients receiving interprofessional admission to discharge reconciliation supported by an electronic platform) was compared to a control group of those not receiving interprofessional discharge reconciliation.  The outcome was defined as a composite of emergency department or hospital readmissions within 30 days of the index discharge.  A multivariate logistic regression model was used to adjust for age, gender, number of medications, and LACE index.

Results: From 2007-2011, a total of 24,524 unique patient visits (n= 20,319 patients) met the criteria of the study. The main analysis of GIM patients (n=8678) did not detect a difference in outcomes between the intervention group (540/2541) and control (1423/7390) for the primary endpoint of 30 day post-discharge hospital visits.  The adjusted odd’s ratio was 1.058 (21.25% vs. 19.26%, 95% CI 0.945-1.19, p= 0.326).  Increasing number of medications, LACE index score, as well as male gender were independently correlated with a higher risk of hospital visits (univariate analysis).  Also, subgroup analyses of high-risk groups:  patients ≥65 years, LACE index ≥10, those on high-alert medications, and ≥10 medications also did not detect a statistically significant outcome difference between groups.

Conclusion: A 5 year observational evaluation of interprofessional medication reconciliation did not detect a difference in 30 day post-discharge patient hospital visits.   Future prospective studies could focus on an enhanced reconciliation intervention bundle on avoidable “medication-related” hospital admissions and post-discharge adverse drug events.