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The Rural PILL Program: A Postdischarge Telepharmacy Intervention for Rural Veterans.

Rebello KE, Gosian J, Salow M, Sweeney P, Rudolph JL, Driver JA. The Rural PILL Program: A Postdischarge Telepharmacy Intervention for Rural Veterans. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2017 Jun 1; 33(3):332-339.

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Abstract:

PURPOSE: To evaluate the efficacy of the Rural Pharmacological Intervention in Late Life (PILL) program, a quality improvement initiative in which a Boston-based pharmacist provided postdischarge telepharmacy care to veterans from rural Maine. METHODS: Using an automated screening tool, we identified 100 veterans aged 65 and older who had an acute care admission to VA medical centers in Boston or Maine and were at risk of problems with medication management. The PILL pharmacist called patients the week after hospital discharge to reconcile medications, assess adherence, and identify potentially inappropriate drugs. The pharmacist worked with each veteran's family and providers to resolve problems and increase support. To determine whether the intervention decreased acute care admissions, rehospitalizations, or deaths, we matched 1 unique control to each PILL patient by age, hospital location, length of stay, admitting service, and reason for admission. Logistic regression was performed to determine the OR and 95% CI of the outcomes. RESULTS: Patients were discharged on an average of 16 medications and with 4.4 medication changes. Overall, 61% of patients had clerical errors in the discharge summary, and potential clinical concerns were identified in over 75%. Veterans who received the intervention were 70% less likely than controls to have an acute care visit at 30 days postdischarge (7 vs 20 patients; OR = 0.30; 95% CI: 0.12-0.75). There was no difference in rates of hospital readmission or mortality. CONCLUSION: This pharmacist-led phone-based program was effective in decreasing acute care utilization within 30 days after hospital discharge.





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