COMPARING SERVICE MODELS: PHARMACIST-ASSISTED TRANSITION OF CARE (TOC) VERSUS STANDARD OF CARE (SOC) TOWARDS EFFECT ON HEALTHCARE RESOURCE UTILIZATION AMONG PATIENTS FROM MEDICAL WARDS
Received 2020-10-17; Accepted 2021-09-15; Published 2021-10-10
Keywords:Transition of care, Healthcare resource utilization, Bedside dispensing, Medication reconciliation, Readmission
Introduction: Suboptimal care transition post-discharge may potentially increase subsequent healthcare system utilization. Transition of care is a service approach to support continuum of patient care after discharge. Objectives: This study aimed to compare the effect of pharmacist-assisted transition of care versus standard care models towards healthcare resource utilization among medical ward patients.
Methods: A cluster randomized controlled study was conducted among medical ward patients in a Malaysian secondary hospital from July to December 2019. Intervention group received pharmacist-assisted discharge medication reconciliation, bedside discharge medication delivery with counselling and a timely post-discharge callback. Control group followed standard discharge process with medication collection at ambulatory pharmacy without post-discharge phone calls. Study endpoints included pharmacy first refill persistency, resolution on unintended discharge medication discrepancies and 30-days all-cause rehospitalization.
Results: A total of 168 patients with 84 patients in each arm were recruited. Intervention resulted a higher pharmacy first refill persistency (70.2% versus 50.0%, p<0.05), indicating a lowering in subsequent unscheduled refill rate. Under intervention, consistent rate of resolution from discrepancies (100.0%, IQR 0 versus 100.0%, IQR 67; p<0.05) was demonstrated that corresponded to medication cost-savings of RM6.80 per prescription over control. Unplanned rehospitalization was not significantly different between groups (p>0.05) but towards a trend of 10% reduction after intervention.
Conclusion: Pharmacist-led transition care model demonstrated promising effect towards a reduction in healthcare resource use compared to standard care. Future studies for its standardization across institutions are warranted to facilitate service expansion.
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