(1043) Evaluation of Pharmacist-led meds2beds Service Improvement Initiative Impact on Older Adults

Objectives: Medication adherence can be defined as whether patients take their medications as prescribed and take them for the continued duration without discontinuing. The causes for decreased medication adherence are multi-factorial and relate to various patient specific variables. Many patients may stop taking medication if they do not feel the medication is working or they may discontinue the medication when they feel better after taking it for some time. For older adults, it may be difficult for patients to manage their medications due to complexity of the regimens. When patients are hospitalized, it is essential that pharmacists conduct an accurate medication reconciliation prior to administration of any medications. Once they are ready to be discharged, pharmacists may provide valuable discharge education to patients. However, many patients may not be given adequate medication education before leaving the hospital, leading to decreased adherence and impaired health outcomes which may lead to an increase of avoidable hospital re-admissions. Meds2Beds is a clinical service offered across the country to improve patient health outcomes by enhancing provision of patient education and increasing adherence which can lead to an overall decrease in hospital re-admissions. In 2016, a study was conducted at an academic medical center utilizing this service, and the researchers found a 27% reduction in readmissions during the intervention period. In 2019, a similar, student-pharmacist led counseling program was provided to discharged patients, which led to improvement in quality of patient care with reductions in 30-day re-admissions. The objective of this research is to determine if medication education provided by a community pharmacist can improve patient education leading to an overall decrease in 30-day re-admissions to the urban medical center.

Methods: A single center, interventional study will be conducted on older adult patients over a 4-month period. Patient inclusion criteria are patients between the ages 65-89 years old and preparing to be discharged by the time of medication delivery. Exclusion criteria include cognitive impairment as these patients will not be able to adequately comprehend medication education. The community pharmacist will receive discharge medication prescriptions, fill, dispense and package in tamper-evident packing. The community pharmacist will then deliver medications to each patient’s hospital room or nursing staff and provide medication education to the patient. Medication education will include medication indication explanation, administration directions, common adverse effects, missed dose instructions and appropriate discontinuation instructions for rare/life-threatening reactions or adverse effects. The community pharmacist will be available prior to discharge to provide any additional clarification or counseling if needed by the patient. Each patient discharged with Med2Beds services will be followed up with by a community pharmacist within 24-72 hours after education to ensure they have been discharged from the hospital, received their medications and to provide additional counseling or answer any questions the patient may have. The comparison group will be patients that do not receive direct discharge counseling from the community pharmacist. A baseline report will be collected from the start of the 4-month data collection period to assess 30-day hospital re-admission rates. This list will then be used to determine if re-admission rates were decreased with direct patient counseling in patients that received said counseling vs those that do not. Patient information will be collected and stored at the dispensing community pharmacy. Descriptive statistics will be utilized to describe the baseline characteristics of the sample. A multiple logistic regression model will be utilized to determine if receipt of the community pharmacist administered counseling is predictive of a lower hospital readmission rate. An alpha value of 0.05 will be utilized to determine statistical significance.

Results: N/A

Conclusions: N/A