CLEVELAND – A pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients showed good results at the Louis Stokes Cleveland VAMC in Cleveland.
The report, published in Progress in Cardiovascular Diseases, noted that transitions of care in HF should include:
- medication reconciliation,
- multidisciplinary care,
- early post-discharge follow-up, and
- prompt intervention on HF signs and symptoms.
The VA pharmacy authors hypothesized that combining the elements with optimization of medications would positively affect outcomes.1
The SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC) was used to test that. Patients were seen by a heart-failure trained clinical pharmacist, who performed medication reconciliation, a basic physical exam, and a HF symptom history. All of the 135 patients had a diagnosis of HF, with 59% having been recently discharged from the hospital.
During the pilot, medications were adjusted by the clinical pharmacist or medical provider. Data were retrospectively collected for a quality improvement evaluation of this novel clinic on medication discrepancies, medications optimized, and 30-day readmissions…
Results indicated that the mean time from discharge to the clinic appointment was 10+6 days, and the 30-day all-cause readmission rate was 9%. Study authors reported that medication discrepancies were detected in 53% of patients.
Medications were optimized in 70% of patients, usually involving beta blockers, ace inhibitors, and diuretics. In patients with an ejection fraction of 40% or below, significantly higher doses of beta blockers and ace inhibitors generally were prescribed after the clinic visit, they said.
“The HF MRTCC identified and corrected numerous medication discrepancies, up-titrated medications, and was associated with a 30-day readmission rate of 9%.,” the researchers concluded. “These encouraging pilot results are hypothesis-generating and warrant further controlled trials.”
1: Milfred-LaForest SK, Gee JA, Pugacz AM, Piña IL, Hoover DM, Wenzell RC, Felton
A, Guttenberg E, Ortiz J. Heart failure transitions of care: A pharmacist-led
post- discharge pilot experience. Prog Cardiovasc Dis. 2017 Aug 18. pii:
S0033-0620(17)30113-5. doi: 10.1016/j.pcad.2017.08.005. [Epub ahead of print]
Review. PubMed PMID: 28826670.
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.