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The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization
Journal article   Peer reviewed

The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization

Joshua M. Pevnick, Michelle S. Keller, Korey A. Kennelty, Teryl K. Nuckols, EunJi Michelle Ko, Kallie Amer, Laura Anderson, Christine Armbruster, Nicole Conti, John Fanikos, …
Contemporary clinical trials, Vol.106, pp.106419-106419
07/2021
DOI: 10.1016/j.cct.2021.106419
PMCID: PMC8276883
PMID: 33932574
url
https://escholarship.org/uc/item/7c78965jView
Open Access

Abstract

Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals. The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission. If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs. Trial registration: ClinicalTrials.gov Identifier: NCT04071951 •Few studies have examined the effectiveness of pharmacist-led medication management interventions in reducing readmissions.•The Pharmacist Discharge Care (PHARM-DC) intervention involves tailored peri- and post-discharge medication management.•This multisite pragmatic randomized trial will study PHARM-DC’s effect on 30-day readmissions and its cost-effectiveness.
 Adverse drug events Geriatrics Medication management Pharmacist Readmissions

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