Follow-Up Visits after Heart Failure Hospitalizations: Impact of a Medication Reconciliation Clinic
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1 Follow-Up Visits after Heart Failure Hospitalizations: Impact of a Medication Reconciliation Clinic Sherry K. Milfred-LaForest, PharmD, BCPS Clinical Pharmacy Specialist, Cardiology and Organ Transplantation Louis Stokes Cleveland VA Medical Center
2 Presenter Disclosure Information Sherry K. Milfred-LaForest, PharmD, BCPS Championing QI in 2 Hours a Week» QI Examples from the Field Follow-Up Visits after Heart Failure Hospitalizations: Impact of a Medication Reconciliation Clinic Financial Disclosures» No relevant financial relationships exist Unlabeled/Unapproved Use Disclosure» None
3 Follow-Up for ADHF Hospitalizations Recent literature suggests quick follow-up following HF hospitalization impacts readmission rates» What needs to happen at this visit? Review recent symptoms since discharge Ensure medication and diet adherence Determine if medication titration is needed Education if needed Hernandez AF. JAMA. 2010;303:1716.
4 SERIOUS Model for Medication Reconciliation Solicit (from patient) - Medications and allergies from patient at each encounter, including all medications and herbal supplements - Obtain information from other pharmacies if needed Examine - At each inpatient and outpatient encounter - Look for discrepancies in doses, frequencies between list and reported regimen Reconcile - Compare home list and list in medical record, make changes to make them match as appropriate - Reconcile with interactions and allergies and take appropriate actions Inform - Educate patients and caregivers about indications and adverse effects of medications Optimize - Optimize medication doses to target guidelines or to improve symptoms - Reduce medications if appropriate to address polypharmacy or improve adherence Update - Update list with appropriate changes Share - With patient/caregiver when leaving and all other providers Hoover D. IHI National Forum [Abstract]
5 Medication Reconciliation Clinic Flow Staffed by pharmacists» Clinical pharmacists as preceptors» Nurse practitioner/physician available» Symptom evaluation (vitals, questionnaire)» Focus on medications Education, self-management tools, pill box fills One half day per week» 6 slots, 1hr each
6 Clinic Evaluation Total Population (n=122) Post Hospital Discharge (n=73) Systolic Dysfunction (n=67) Age (mean + SD) years years years EF < 40% 55% 50% 100% Oral/Injectable/Inhaled Medications mean (range) 15 (4-27) 14 (4-26) 13 (6-24) Medication Discrepancies 52% (n=64) 52% (n=38) 51% (n=34) Number of Discrepancies mean (range) 3 (1-12) 3 (1-12) 3 (1-12) Medication Optimization 71% (n=87) 71% (n=52) 75% (n=50) Number of Medications Optimized median (range) Days between discharge and clinic visit (mean + SD) 2 (1-5) 2 (1-5) 2 (1-4) n/a days n/a 30-day all cause readmission rate % (mean number of days) n/a 8% (16 days) n/a Mortality within 30 days 1.6% (n=2) 2.7% (n=2) 1.4% (n=1) Milfred-LaForest S. HFSA [Abstract]
7 Medication Optimization Medications Optimized at Visit 19% 5% 5% ACEi/ARB 18% BB 23% Diuretics 19% Ald Antag 7% Nitrates 8% Hydralazine 8% Other CV 16% Cardiovascular Diabetes Inhalers Other N = % Milfred-LaForest S. HFSA [Abstract]
8 Mean Daily Doses in Patients with EF < 40% mg/day Beta-Blocker Doses 0 P < Metoprolol Equivalents Pre-Clinic Post-Clinic mg/day ACE Inhibitor Doses P > Lisinopril Equivalents Milfred-LaForest S. HFSA [Abstract]
9 Next Questions - So, we seem to be doing something right, but» Difficulty getting patients to agree to come to clinic after discharge How do we get the right patients into the clinic in an appropriate time frame?» By nature of patients referred, high noshow rate How do we improve?
10 Current Approaches Dedicated person to schedule and do reminder calls» Began in February 2010 Schedules patients in computer and troubleshoots travel issues Reminds patients of appointment AND to bring their medication bottles (not just the list) Advertise clinic through HF steering committee to cardiology and medicine services
11 Current Approaches Consult pathway» Implemented September 2010» Available for all inpatient teams and PCPs to refer patients to clinic through VA records system Goal to get patients scheduled prior to discharge In process of collecting information on time to follow-up post discharge and no-show rates
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