BACKGROUND AND PURPOSE: 

• Approximately 5% of hospital admissions can be attributed to drug reactions 
• Ravn-Nielsen et al. (JAMA Int Med, 2018) examined whether multifaceted pharmacist interventions can prevent further hospital and emergency department visits

METHODS: 

• Randomized clinical multicenter study (RCT) 
• Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer (OPTIMIST), conducted in Denmark  
• Participants: Medical patients in an acute admission ward, ≥18 years and were using 5 or more medications 
• The medication review and patient interviews were conducted in the hospital and followed up in collaboration with primary care 
• The patients were randomized into the following groups 
  • Usual care (no intervention) 
  • Basic intervention: Structured, patient-centered medication by a clinical pharmacist after (1)admission; (2)lab data available; (3)primary medical admission note written 
  • Extended intervention: (1)medication review as above; (2) three motivational interviews; (3)follow-up with primary care physician, pharmacy, and nursing home) 
• The primary outcomes  
  • Readmission within 30 or 180 days  
  • Emergency Department (ED) visits within 180 days 
• Primary composite endpoint: readmission or ED visit within 180 days 
• Secondary outcomes  
  • Drug-related readmissions within 30 and 180 days after inclusion 
  • All-cause mortality and drug-related mortality

RESULTS: 

• 1,499 patients were enrolled in the study 
• Extended intervention resulted in  
  • Decreased readmission within 30 days (hazard ratio [HR], 0.62; 95% CI, 0.46-0.84) 
  • Decreased readmission within 180 days (HR, 0.75; 95% CI, 0.62-0.90)  
  • Decreased primary composite endpoint (HR, 0.77; 95% CI, 0.64-0.93) 
• There was no significant reduction in drug-related readmissions 
  •  Within 30 days (HR, 0.65; 95% CI, 0.39-1.09)  
  •  Within 180 days (HR, 0.80; 95% CI, 0.59-1.08)  
• There was no significant reduction in deaths (HR, 0.83; 95% CI, 0.22-3.11) 

CONCLUSION: 

• Interaction with a hospital pharmacist, using a multi-faceted approach, may reduce the number of ED visits and hospital readmissions 
• Authors acknowledge potential “political or other barriers toward allocating a large budget for such intervention”

Learn More – Primary Sources: 

Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission

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