Should Pharmacists Be Included in a Core Team to Reduce Hospital Admissions and Mortality for Patients With Chronic Heart Failure?
heart failure intervention, chronic disease management
Background/Aims: Heart failure (HF) is a common disease and accounts for multiple hospital admissions, readmissions, increasing health care costs and high mortality. One in five Americans is diagnosed with HF. Symptoms are mostly managed with medications. Evidence shows that a multidisciplinary care team is best practice for managing HF. More research is needed to determine ideal combinations for services on a core team to optimize use of resources and intervention effectiveness. We aimed to determine the impact on outcomes of adding a clinical pharmacist intervention to a HF multidisciplinary care team. We hypothesized that a pharmacist would increase efficiency of the team, and thereby improve outcomes of decreased hospitalization and mortality.
Methods: We conducted a prospective, pretest-posttest nonrandomized, single-arm, pilot study to determine impact of adding a pharmacist intervention. In an ambulatory care setting, 100 patients who were hospitalized with HF in prior 12 months were invited to participate; 81 patients consented, enrolled and completed the study. Retrospective data on 81 other comparable patients, admitted for HF in prior 12 months, served as controls. Control patients had received usual care from the multidisciplinary care team, whereas study patients received usual care plus pharmacist intervention. The intervention R-E-A-D was comprised of four steps –– Step 1: Reconciliation of medications; Step 2: Education to patient/caregiver on indications for medications; Step 3: Adherence evaluation; and Step 4: Drug monitor for drug adverse effects, drug/disease interactions and therapy optimizations. The study was conducted from May 2010 to November 2011.
Results: Demographic variables included average age 75 years, average medications 10 and average comorbidities 5. At 12 months postintervention, the control group realized a decrease of 32 hospital readmissions and a reduction of 60 hospital days (P=0.16), while the intervention group realized a decrease of 97 readmissions and a reduction of 332 hospital days (P<0.001). Postintervention, 23 of 81 patients (28%) had expired in the control group, while 13 of 81 patients (16%) had expired in the treatment group
Discussion: The study confirms that pharmacists should be included as members of a core team to reduce readmissions and mortality for patients with chronic HF.
Vardhan I, Grant YE, Astrea C, Wolmer J, Hinz P. Should Pharmacists Be Included in a Core Team to Reduce Hospital Admissions and Mortality for Patients With Chronic Heart Failure?. J Patient Cent Res Rev 2015;2:102. http://dx.doi.org/10.17294/2330-0698.1109
March 31st, 2015
April 28th, 2015