The Medication REACH Program

Purpose: Data from the literature suggests that one out of every five patients discharged from a hospital setting will experience an adverse event, with 72% of these adverse events being medication-related. When patients transition from one setting to another, there is often a disconnect between hospitalists, primary care physicians, community pharmacists, patients and caregivers. This lack of communication can result in adverse events and increased hospital readmissions. The medication REACH program (Reconciliation, Education, Access, Counseling, Healthy patient at home) at Einstein Medical Center was implemented to address medication management issues at discharge in high-risk patients with acute myocardial infarction, congestive heart failure and hypertension. The overall goal of this program was to prevent hospital readmissions through interventions made by clinical pharmacists.

Methods: 89 patients (17% with acute myocardial infarction, 48% with CHF, and 82% with hypertension) were randomized to receive traditional nurse-mediated or clinical pharmacist-mediated discharge counseling. Four clinical pharmacists were directly involved in performing medication reconciliation, providing patient-centered education, resolving issues related to medication access, and completing medication ­counseling “after care” calls. The purpose of the call was to review medication regimens, resolve any medication-related issues and reiterate the importance of medication adherence. 

Results: Patients in the intervention group were less likely than those in the control group to be readmitted to the hospital within 30-days post discharge (10.6% vs. 23.8%, respectively). Despite these results, the difference was not statistically significant (p=0.085). A total of 59 medication management interventions were made by clinical pharmacists, with the most common being the initiation of a medication therapy (25%).

Conclusion: The medication REACH program demonstrates the importance of clinical pharmacists in the setting of care transitions. Implementing a program to address medication management issues at discharge decreased 30-day hospital readmission rates, although further research with larger samples is warranted.