Ensuring continuity of patient care across the healthcare interface, Telephone follow‐up post hospitalisation

Abstract

Aim

To implement pharmacist‐led, post‐discharge telephone follow‐up (TFU) intervention and to evaluate its impact on rehospitalisation parameters in polypharmacy patients, via comparison with a well‐matched control group.

Method

Pragmatic, prospective, quasi‐experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine Integrated Medicines Management (IMM) service.

Results

Using an intention to treat approach, reductions in 30‐ and 90‐day readmission rates for intervention patients compared with controls were 9.9% (Odds Ratio [OR]= 0.57; 95% CI: 0.36‐0.90; P<0.001) and 15.2% (OR= 0.53; 95%CI: 0.36‐0.79; P=0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9‐74.9) for intervention group compared with 60.1 days (95%CI: 55.4‐64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs 6.7 days; P<0.001). Benefit: cost ratio for 30‐day readmissions was 29.62, and 23.58 for 90‐day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire (BMQ), was reduced 3.2 (95%CI: ‐4.22 to ‐2.27; P<0.001). Mean difference in Medication Adherence Report Scale (MARS) was 1.4 (22.7 vs 24.1; P<0.001). Most patients (83.8%) reported having better control of their medicines after the intervention.

Conclusions

Pharmacist‐led post‐discharge structured TFU intervention can reduce 30‐ and 90‐day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self‐reported adherence and satisfaction.

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