CPF FUNDED GRANT DETAILS

The incidence of medication discrepancies is high following discharge from the hospital and medication-related problems are a common cause of hospital readmissions. Proper medication reconciliation and counseling at or around the time of discharge can identify and resolve medication-related discrepancies. There is a great need for patient counseling and follow-up post-discharge for early detection of medication-related problems. Community pharmacists can provide medication therapy management MTM services to identify these problems and potentially decrease readmission rates. While it is shown that counseling by inpatient hospital pharmacists can reduce 30-day readmissions, the impact of community pharmacists in the transition of care process is not well-studied. The purpose of this project is to implement a targeted MTM service in a community pharmacy in collaboration with local hospitals for patients admitted for myocardial infarction, heart failure, or pneumonia in order to 1.identify, characterize, and resolve medication reconciliation related discrepancies and 2.decrease 30-day hospital readmissions. Discharge planners will notify the pharmacy of the patients anticipated discharge on the second day of admission and MTM services will occur within 72 hours of discharge following the receipt of a discharge summary. These services will occur in a community pharmacy with a strong reputation for successful and sustaining clinical services such as MTM and employer-based diabetes and hypertension counseling programs. To determine outcomes of the intervention, 30-day readmission rates will be monitored and compared to a control group of patients receiving usual care.