This paper is to analyze the impact of ambulatory care pharmacists on reduction of 30-day readmission rates of HDF （hospital discharge follow-up） patients and to assess a link between readmission rates and medicatio...This paper is to analyze the impact of ambulatory care pharmacists on reduction of 30-day readmission rates of HDF （hospital discharge follow-up） patients and to assess a link between readmission rates and medication appointment compliance as well as medication discrepancies. This was a retrospective, single-center study that included all adult patients scheduled for HDF appointments at the UIM （university internal medicine） clinic of the MUSC （Medical University of South Carolina） from May 1, 2013 through December 31, 2013. A total of 470 patients were included with 190 patients attended their scheduled HDF appointments with their PCPs （primary care providers） and the ambulatory care pharmacists, and 280 patients attended their scheduled HDF appointments only with their PCPs. The 30-day readmission rate was 22% in patients who attended HDF appointments with both of the healthcare providers versus 41% in patients who attended HDF appointments only with their PCPs （P 〈 0.05）. Medication errors and discrepancies are common during transitions of care. However, ambulatory care pharmacists play a crucial role in significantly reducing 30-day readmission rates after hospital discharge by providing thorough and complete medication reconciliation services.展开更多
BACKGROUND Treatment for offenders with mental disorders is a key concern in public mental health.Provision of adequate psychiatric treatment is important for the offender and their community.An approach used in Japan...BACKGROUND Treatment for offenders with mental disorders is a key concern in public mental health.Provision of adequate psychiatric treatment is important for the offender and their community.An approach used in Japan to address this issue is administrative involuntary hospitalization.Under this scheme,a person at risk for harming themselves or others because of a mental disorder can be involuntarily hospitalized in a designated psychiatric hospital.However,this scheme does not include tracking of these patients after discharge.Although some data for administrative involuntary hospitalizations are available,it remains unclear what happens to these patients after discharge.AIM To evaluate follow-up of patients under administrative involuntary hospitalization after discharge and obtain data for later comparisons with outcomes.METHODS We used a retrospective design and conducted a national survey of administrative involuntary hospitalizations.Questionnaires were distributed to 939 facilities across Japan.The questionnaire collected data for selected involuntary hospitalization cases in the hospital on June 30,2010(census date),and the prognoses of each patient on a specified date in 2011 and 2012.We also asked about the treatment provided to each patient.We stratified patients by prognosis(good or poor),and used logistic regression analysis to examine the relationship between treatment and prognosis.RESULTS We received completed questionnaires from 292 facilities(response rate 31.1%);105 facilities had no relevant patients.Our analysis included data for 394 patients with valid data.Official statistics indicated 1503 patients were under administrative involuntary hospitalization as at June 30,2012,meaning the capture rate was 27.2%.Approximately a fourth(104/394)at 1 year,and a third(137/294)at 2 years after the census had unknown prognosis.Treatment content included multi-disciplinary team meetings(78.2%of patients),counseling by public workers(59.9%),and discussion with external specialists(32.5%).Overall,116 patients were categorized as having a good prognosis at 1 year,and 168 had a poor prognosis.At the 2-year point,102 patients had a good prognosis and 150 had a poor prognosis.“Discussion with external specialists”was positively associated with a good prognosis at both 1 year(P=0.016)and 2 years(P=0.036).CONCLUSION We found that facilities in Japan currently have limited ability to track the prognoses of patients who were hospitalized involuntarily.Discussion with external specialists is associated with a good prognosis.展开更多
文摘This paper is to analyze the impact of ambulatory care pharmacists on reduction of 30-day readmission rates of HDF （hospital discharge follow-up） patients and to assess a link between readmission rates and medication appointment compliance as well as medication discrepancies. This was a retrospective, single-center study that included all adult patients scheduled for HDF appointments at the UIM （university internal medicine） clinic of the MUSC （Medical University of South Carolina） from May 1, 2013 through December 31, 2013. A total of 470 patients were included with 190 patients attended their scheduled HDF appointments with their PCPs （primary care providers） and the ambulatory care pharmacists, and 280 patients attended their scheduled HDF appointments only with their PCPs. The 30-day readmission rate was 22% in patients who attended HDF appointments with both of the healthcare providers versus 41% in patients who attended HDF appointments only with their PCPs （P 〈 0.05）. Medication errors and discrepancies are common during transitions of care. However, ambulatory care pharmacists play a crucial role in significantly reducing 30-day readmission rates after hospital discharge by providing thorough and complete medication reconciliation services.
基金Supported by a grant awarded to the corresponding author from the Japanese Ministry of Health,Labour and Welfare as part of a research project entitled “Research of the inclusive care for the psychiatric patients discharged from involuntary admission by the prefectural governor’s order”
文摘BACKGROUND Treatment for offenders with mental disorders is a key concern in public mental health.Provision of adequate psychiatric treatment is important for the offender and their community.An approach used in Japan to address this issue is administrative involuntary hospitalization.Under this scheme,a person at risk for harming themselves or others because of a mental disorder can be involuntarily hospitalized in a designated psychiatric hospital.However,this scheme does not include tracking of these patients after discharge.Although some data for administrative involuntary hospitalizations are available,it remains unclear what happens to these patients after discharge.AIM To evaluate follow-up of patients under administrative involuntary hospitalization after discharge and obtain data for later comparisons with outcomes.METHODS We used a retrospective design and conducted a national survey of administrative involuntary hospitalizations.Questionnaires were distributed to 939 facilities across Japan.The questionnaire collected data for selected involuntary hospitalization cases in the hospital on June 30,2010(census date),and the prognoses of each patient on a specified date in 2011 and 2012.We also asked about the treatment provided to each patient.We stratified patients by prognosis(good or poor),and used logistic regression analysis to examine the relationship between treatment and prognosis.RESULTS We received completed questionnaires from 292 facilities(response rate 31.1%);105 facilities had no relevant patients.Our analysis included data for 394 patients with valid data.Official statistics indicated 1503 patients were under administrative involuntary hospitalization as at June 30,2012,meaning the capture rate was 27.2%.Approximately a fourth(104/394)at 1 year,and a third(137/294)at 2 years after the census had unknown prognosis.Treatment content included multi-disciplinary team meetings(78.2%of patients),counseling by public workers(59.9%),and discussion with external specialists(32.5%).Overall,116 patients were categorized as having a good prognosis at 1 year,and 168 had a poor prognosis.At the 2-year point,102 patients had a good prognosis and 150 had a poor prognosis.“Discussion with external specialists”was positively associated with a good prognosis at both 1 year(P=0.016)and 2 years(P=0.036).CONCLUSION We found that facilities in Japan currently have limited ability to track the prognoses of patients who were hospitalized involuntarily.Discussion with external specialists is associated with a good prognosis.
