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Evaluation of Pharmacist Discharge Counseling Process in Pulmonary Hypertension Patients

Jessica Humphrey

Anne Miller

K Rechtien

M Hard

Timothy Williamson

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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1052

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.

Purpose

The purpose of this abstract is to evaluate the 30-day readmission rates after an institution-specific pharmacist discharge counseling process was implemented for patients with pulmonary arterial hypertension.

Background

Patients with pulmonary arterial hypertension (PAH) frequently encounter episodes of disease exacerbation characterized by fluid overload and right heart failure resulting in hospitalization. Diuretics are a mainstay in treatment with the goal of decreasing total body volume in order to decrease stress on the heart to increase cardiac output and cardiac index. These patients present an opportunity to incorporate pharmacists into the discharge process by counseling on diuretics, fluid restriction, and diet compliance. Similar education has been associated with decreasing left-sided heart failure admissions therefore, it can be presumed to decrease admissions in the PAH population.

Methods

The original study in 2015 found the most common reason for hospital admission was PAH exacerbations secondary to fluid overload in patients on prostacyclin therapy. Implementation of a standardized discharge process was a key phase of the previous study which included a patient specific diuretic handout and electronic communication with the outpatient PH nurses. Phase 3 of the original study assessed the effect of the discharge process by evaluating 30 day readmission rates and the reason for readmission with the intended outcome of decreased admissions. Although no difference in 30-day readmissions was found at that time, positive outcomes with outpatient PH clinic nurses was noted via survey. Since that study, the pharmacists’ education and workflow has been continued for patients on any PAH therapy and diuretics. As a follow-up, this specific abstract is assessing compliance of the pharmacist education process and how it may affect 30-day readmission rates from May 1, 2015 to September 30, 2017, after the completion of the previous study.

Results

There were 11 patients that met criteria for inclusion with volume overload, once again, being the most common reason for re-admission (45.5%). Of the patients readmitted within 30 days for fluid overload, 80% were counseled by a pharmacist and 60% of the counseling notes were forwarded to the outpatient PH nurse.

Conclusions

Possible reasons why patients were not counseled by a pharmacist include patients being discharged from the intensive care unit, patients on a care team without a PH-specialized pharmacist, and PH pharmacist(s) unaware of admission if not on prostacyclin therapy. The low number of total 30-day readmissions over a 2.5 year period (n=11) may indicate, among other processes and standards of patient care, that pharmacist counseling benefits this patient population.