Lower Readmission Rates Associated with Pharmacist-Assisted Transitional Care Program

And other news from the 12th HOPA Annual Conference
TOP - May 2016, Vol 9, No 2 - Conference Correspondent
Meg Barbor, MPH

Lower Readmission Rates Associated with Pharmacist-Assisted Transitional Care Program

Atlanta, GA—During transitions of care, medication-related errors and adverse effects occur, and contribute to unplanned readmissions ≤30 days following hospital discharge, particularly among oncology patients.

According to data presented at the 12th Hematology/Oncology Pharmacy Association (HOPA) Annual Conference by Phuong Dao, PharmD, PGY2 Hematology/Oncology Pharmacy Resident, Boston Medical Center (BMC), and colleagues, there have been no studies to date evaluating the effect of a transitional care program on reducing readmissions for the oncology patient population. Between August 1, 2015, and January 31, 2016, the study authors conducted a retrospective review evaluating the impact that the transition of care process (eg, pharmacist interventions) has on unplanned, 30-day readmission rates of inpatient oncology services.

At BMC, the current standard of care for inpatient oncology services is providing transitional care management (TCM) to patients who are deemed moderate or high risk for readmission. This includes communicating with the patient and/or caregiver ≤2 business days following discharge, and having face-to-face visits in the 7 to 14 calendar days after discharge, depending on the complexity of the medical decision-making involved.

A total of 133 patients, 50% of whom were men, and with a mean age of 61 years, were evaluated; all patients were discharged and sent home with a life expectancy of >30 days, and a follow-up appointment scheduled at BMC’s oncology clinic.

The average, 30-day unplanned readmission rate during this 6-month pilot of patients receiving TCM was 25.6%, and, among patients who did and did not complete the TCM process, was 18.7% and 37%, respectively; the difference was considered statistically significant (P = .0074) by the study authors.

“Readmission rates of patients who completed the TCM process were lower than patients who did not complete the TCM process, suggesting that timely follow-up through transitional care services reduced unplanned readmissions,” reported Dr Dao and colleagues.

Pharmacists identified errors in more than half of the discharge medication reconciliations completed by the physician, and were able to intervene with more than half of patients reached via telephone follow-ups. According to the investigators, because of the significant amount of time and resources pharmacists dedicated to the program, their involvement helped identify errors to reduce patient harm and optimize patient care.

In the future, pharmacists will review the discharge medication reconciliation for all patients discharged from the inpatient oncology service to minimize medication errors, the study authors concluded.

Reference

Dao P, Stebbings A, Gignac G, Sane R. Evaluating the impact of a pharmacist-assisted transitional care program on readmission rates of an inpatient oncology service. Poster presented at: 12th Hematology/Oncology Pharmacy Association Annual Conference; March 16-19, 2016; Atlanta, GA.

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Adequate Vitamin D Levels Linked to Shorter Time to Engraftment

Sufficient vitamin D levels are associated with a shorter time to engraftment in autologous stem-cell transplant [SCT] patients, according to new research led by Chelsea M. Gustafson, PharmD, PGY2 Hematology/Oncology Pharmacy Resident, Northwestern Memorial Hospital, Chicago, IL.

Vitamin D is a steroid hormone that crucially contributes to immune and inflammatory modulation and mediation of calcium and phosphate balance. Although one-third of Americans have insufficient vitamin D levels, this number has been reported to be as high as 89% in preallogeneic SCT patients.

Because this association has yet to be reported on in the literature, Dr Gustafson and colleagues sought to evaluate the relationship between vitamin D levels and the number of CD34+ cells collected during mobilization, as well as time to neutrophil engraftment in adult autologous hematopoietic SCT patients.

Using a retrospective, single-center, cohort study in autologous SCT patients, the investigators compared those with low vitamin D levels to those with normal vitamin D levels.

The study compared outcomes for 283 patients with multiple myeloma receiving their first autologous SCTs based on vitamin D levels. Sufficiency was defined as vitamin D ≥30 ng/mL (n = 85), and insufficiency as <30 ng/mL (n = 198).

“Data analysis revealed a statistically significant difference in time to engraftment when comparing patients with sufficient vitamin D levels to those with insufficient vitamin D levels,” Dr Gustafson and colleagues reported. “This difference in time to engraftment did not lead to a difference in length of stay.”

Although the study authors concluded that there was a link between shorter time to engraftment and sufficient vitamin D levels, the other primary end point—number of stem cells mobilized—yielded no statistically or clinically significant differences.

Reference

Gustafson CM, Hicks AD, Wojenski DJ, Galvin JP. Effect of vitamin D levels on mobilization and engraftment in autologous stem cell transplant patients. Poster presented at: 12th Hematology/Oncology Pharmacy Association Annual Conference; March 16-19, 2016; Atlanta, GA.

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Complete Remission Higher for Patients with AML on FLAG-Based Regimens

Complete remission (CR) rates were higher among patients treated with fludarabine, high- or intermediate-dose cytarabine, and granulocyte colony-stimulating factor (FLAG)-based regimens versus mitoxantrone and etoposide (ME)-based regimens for relapsed or refractory acute myeloid leukemia (AML), according to research from investigators at the Department of Pharmacy Services, Virginia Commonwealth University Health System (VCUHS), Richmond.

AML is the most common leukemia in adults, and is relapsed or refractory in 80% of patients with the disease; 1-year overall survival is <30% in this patient population. In addition, patients with AML secondary to myelodysplastic syndromes exhibit poor prognoses, with CR rates of approximately 45% after initial induction therapy, which makes them more similar to patients with relapsed and/or refractory AML than untreated patients with the condition.

Although there is no current standard of care for salvage therapy, FLAG-based therapy yields CR rates between 52% and 55%—57% with the addition of idarubicin (FLAG plus Ida) , according to the investigators. ME-based therapy produces CR rates between 34% and 42.6%, and CR rates of ≤59% to 66% with the addition of intermediate-dose cytarabine (ME plus Ara-C).

Before the 2011 national cytarabine drug shortage, VCUHS treated patients with relapsed and/or refractory AML primarily with FLAG-based therapies. During the shortage, however, more patients were treated with ME-based regimens. Kathryn T. Maples, PharmD, PGY1 Pharmacy Resident, VCUHS, and colleagues sought to compare the efficacy and safety of both salvage chemotherapy regimens in their institute’s patients, and identify characteristics associated with achieving CR.

They conducted a 5-year, single-center, retrospective medical record review of 69 patients who received FLAG- or ME-based regimens between January 1, 2010, and December 31, 2014. A total of 13 patients—8 of whom were men—received the ME plus Ara-C regimen, and 56—33 of whom were men—received the FLAG plus Ida regimen.

“Patients treated with FLAG had an 8.5 times higher CR rate than patients treated with ME,” Dr Maples and colleagues reported. “Those with primary refractory disease had a 16.7 and 7.31 times higher CR rate than patients having [myelodysplastic syndromes]-AML…or first relapse…respectively.”

When adjusted for treatment regimen, cytogenetics were not shown to be a significant predictor for CR when adjusted for treatment regimen, and no differences were observed between the treatment groups with regard to rates of neutropenic fever or mean length of stay.

Reference

Maples KT, Liu H, Sima AP, Culver M. Comparison of fludarabine and cytarabine-based regimens to mitoxantrone and etoposide-based regimens for relapsed or refractory acute myeloid leukemia. Poster presented at: 12th Hematology/Oncology Pharmacy Association Annual Conference; March 16-19, 2016; Atlanta, GA.

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Last modified: August 23, 2016