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An Evaluation of the Impact of Clinical Pharmacists on Care Transitions in a Non-Integrated Healthcare System


Medication errors and medication non-adherence can contribute to adverse drug events, poor health outcomes, and avoidable hospitalizations and emergency department (ED) visits. Patients are at increased risk for medication-related problems during transitions of care. The causes include inaccuracies in medication lists upon admission to the hospital, documentation errors caused by inadequate communication among providers, and insufficient education provided to patients regarding changes to their medication regimens. The objective of this dissertation is to evaluate the impact of two care transition interventions at UCLA Health that aimed to reduce hospital readmissions and ED visits by improving medication accuracy and patient adherence to medications following hospitalization.

The analyses undertaken in this dissertation use health system administrative data to (1) evaluate the impact on hospital readmissions and ED visits of a hospital to home care transitions program that included a home visit by a health coach, and a review and modification of medications as needed by a clinical pharmacist in coordination with the patient’s primary care provider; (2) document the prevalence and types of medication-related problems and discrepancies that occur and persist following a patient’s transition from hospital to home; and (3) evaluate the impact on hospital readmissions and ED visits of a pilot program that used a clinical pharmacist in a skilled nursing facility (SNF) to manage medications between the hospital, post-acute care setting, and home. Propensity score and multivariate regression approaches as well as qualitative methods were used to evaluate the interventions.

Results from the first study showed that receipt of the intervention was associated with a significantly lower predicted probability of hospital readmissions and ED visits compared with usual care. Results from the second study revealed that clinical pharmacists identified and took action on a wide range of medication discrepancies and medication-related problems following a patient’s hospitalization. Results from the third study showed that patients who were discharged from a SNF to home and who were under the care of a clinical pharmacist had a significantly lower likelihood of being readmitted to the hospital compared with similar patients who received usual care. In summary, the results demonstrate that clinical pharmacists can play an important role in decreasing the risk of poor outcomes following care transitions, and that strengthening the linkage with the primary care system is a potentially necessary component for facilitating safe and effective care transitions.

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