Pharmacist home visits reduce hospital readmissions

A pilot program that provides home visits from a pharmacist reduced the number of preventable hospital readmissions for frail elderly patients, according to a report from HealthPartners.

Related: Five hospitals successfully reducing readmissions

Started as a pilot in 2014, the medication therapy management (MTM) home visit program focuses on patients with serious, chronic illnesses, who take multiple medications and are unable to leave their homes. Patients participating in the program are visited by a clinical pharmacist within a week after leaving Regions Hospital in St. Paul, Minnesota.  

During the visit, the pharmacist reviews medications, helps the patient understand how to take medications as prescribed and evaluates whether there are any safety risks in the home. Patients are not charged for the visits.

In 2016, HealthPartners is expanding this program by partnering with Ramsey County paramedics to provide MTM home visits to patients with heart failure.

Before the pilot program, Regions Hospital readmission rates were at national averages. With the goal of continued reduction in readmissions, HealthPartners piloted a new program in 2014 aimed at providing additional services to home bound dual-eligible Medicare/Medicaid patients due to their higher-than-average hospital readmissions.

Among patients who received a home visit in the first year, 6% were readmitted to Regions Hospital within 30-days after a hospital stay compared to 16% readmission for patients who chose not to receive the MTM home visits, according to Dan Rehrauer, HealthPartners senior manager, medication therapy management.

Related: Technology to reduce readmissions

HealthPartners intends to complete a more robust analysis, including effects on total cost of care with more data becoming available as the program continues. The health plan has been committed to decreasing hospital readmissions since 2009, with the implementation of programs that reduced overall 30-day readmissions at Regions Hospital from 11.5 to 9.7% over 4 years.

Rehraurer

“Taking the step to reduce hospital admissions builds on the core values of HealthPartners by improving patient experience and health as affordably as possible,” says Rehrauer.

In 2011, there were approximately 3.3 million hospital readmissions in the United States, contributing to $41.3 billion in healthcare costs, according to the Agency for Healthcare Quality and Research. Overall readmission rates were significantly higher among Medicare patients (17.2%) compared to privately insured patients (8.7%).

“Hospital readmission penalties from the ACA [Affordable Care Act] continue to affect thousands of hospitals across the United States each year, with 2,592 hospitals in 2015 receiving financial penalties for higher than benchmark readmission rates,” says Rehrauer. “Regions is not included in the 2,592 hospitals. There is a clear incentive for hospitals to actively reduce readmissions.”

Next: The most common medication problems identified by visits

The most common medication problems identified by the visits include:

• Medication is no longer needed or a new medication is needed.

Interestingly, the most common medication related problem identified in this population is different from what Rehrauer says he sees in HealthPartners’ overall MTM program. 

“In our overall MTM program, the most common problem we identify is the need for additional medication in order to help people reach the goals of their medication therapy,” Rehrauer says. “In our post-discharge home care population, the most common problem we identify is that a medication is no longer needed. This often happens with home care patients who have been taking a medication for years, but over time, the risks of continuing to take the medication outweigh the benefits.”

One example of this is the use of medications to treat heartburn that are continued for years despite the lack of symptoms in the patient, according to Rehrauer. “Stopping the medicine rarely results in a rebound of heartburn, but does reduce the long-term risks of using those medications.”

• Medication is not being taken as prescribed.

“This occurs commonly after a hospital discharge when patients have a very different medication list than they did before they went to the hospital,” says Rehrauer. “They have a mix of their old and new medicine at home and aren’t sure what they are supposed to be taking.  Additionally, with the complicated regimens many patients have, they simply forget to take their medication.”

• A new medication is needed.

Many times, patients will have multiple chronic conditions, with each condition requiring multiple medications. Pharmacists will often find that a patient is missing an important medication that is likely to improve health outcomes.

• Medication dose is too high. 

“This often happens when patients have been taking a medication for years and their condition has changed due to age, other conditions, or other reasons, and no longer requires high doses of medications,” Rehrauer explains.

“Pharmacists make specific recommendations to solve each drug therapy problem that is identified in home MTM visits,” he says. “Pharmacists will work directly with each patient’s care team, including their primary care provider to make the appropriate medication changes. Pharmacists will then follow-up with patients to ensure that the identified problems have been solved, and to continue evaluating for new drug therapy problems.”