Chronic Disease
Conditions
Keywords
Transitions of care, Indigent population, Hospital readmission rates
Brief summary
This study was to show the value of pharmacists in providing transitions of care to and improving health outcomes of uninsured populations. It also aimed to demonstrate the feasibility of implementing a transitions of care program in an indigent care clinic with limited resources. We hypothesized that a pharmacist-led transitions of care program will reduce 30-day hospital readmission rates among the uninsured discharged from a community hospital.
Interventions
BEHAVIORALTransitions of care
The intervention was a pharmacist-led transitions of care program that include medication reconciliation, daily schedule for medication taking and medical condition monitoring, and follow-up phone calls from a pharmacist at 60- and 90-day post-discharge in addition to the usual care.
Sponsors
Auburn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 18 years old or older * Uninsured * English speaking * Discharged from East Alabama Medical Center within the past 16 days
Exclusion criteria
* Patients who did not show up for the first follow-up visit with the study pharmacist after being referred by the care coordinator at East Alabama Medical Center
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 30-day hospital readmission | 30-day post-discharge | Whether a study participant had any hospital readmission 30-day post-discharge |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 90-day hospital readmission | 90-day post-discharge | Whether a study participant had any hospital readmission 90-day post-discharge |
| 30-day emergency department (ED) visit | 30-day post-discharge | Number of ED visits among study participants in each study arm 30-day post-discharge |
| 60-day hospital readmission | 60-day post-discharge | Whether a study participant had any hospital readmission 60-day post-discharge |
| 90-day emergency department (ED) visit | 90-day post-discharge | Number of ED visits among study participants in each study arm 90-day post-discharge |
| 30-day follow-up visit with a primary care provider | 30-day post-discharge | Did a study participant keep a follow-up appointment with a primary care provider |
| 60-day emergency department (ED) visit | 60-day post-discharge | Number of ED visits among study participants in each study arm 60-day post-discharge |
Countries
United States
Outcome results
None listed