MeRIT Project: Instituting a Clinical Pharmacy Case Management Approach to Improve Medication-Related Outcomes in Cirrhosis Patients after Hospital Discharge

Introduction:  A study of cirrhosis patients showed that 69% had at least one non-elective readmission within 1 month and 22% of those readmissions were possibly preventable. Clinical pharmacists are key members of the multi-disciplinary team to assess potential medication related problems and educate patients.

Objectives:  Primary objective was to determine the impact of pharmacy services on health care resource utilization (defined as 30-day readmission rates and ED visits within 72 hours after discharge) for patients with cirrhosis who are seen in transitions of care practice, compared to controls.

Study Design:  Retrospective, comparative evaluation of quality improvement pilot

Methods:  Pilot program was implemented on the Medicine – Hepatology service on 9/28/2015 with intention to run over 12-months. All patients admitted to the service for cirrhosis complications and discharged to home were included. Post-liver transplant patients and those discharged to outside facilities were excluded. Patients were divided into two groups: Group 1 (intervention group) had inpatient and outpatient pharmacist (3 day post-discharge telephone contact) involvement on Tuesdays, Wednesdays, and Thursdays in transitions of care, and Group 2 had usual care on other days of the week.

Results:  Interim analysis was conducted of 65 patients. At hospital discharge, 82.3% of patient presented with medication-related issues (1.6 ± 1.3 interventions/patient). At discharge follow up, 73.5% of patients presented with medication-related issues (2.65 ± 2.1 interventions/patient). 25% of interventions were resolution of medication discrepancies, 22% were providing medication counseling, 22% were referring patients to physicians due to medication concerns, 10% were referring patient to clinic due to worsening condition, and 21% were for miscellaneous reasons. 61.3% of patients in control group and 50% in intervention group were readmitted within 30 days (p=0.36).

Conclusions:  Most patients required medication-related interventions at and after discharge. Most common types of medication-related interventions were medication discrepancies, referral to physician, medication counseling and management of/referral for worsening condition.