Browsing by Author "Roduta, Thomas"
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Item Impact of Real-Time Pharmacy Benefit Information at Point of Discharge on a Provider-Sponsored Health Plan(2018-05) Roduta, Thomas; Wallace, David; Vu, Dominic; Abughosh, Susan M.; Cox, RodneyPurpose: Prescription medications account for nearly 10% of national healthcare expenditures ($3.4 trillion in 2016). Appropriate medication prescribing may reduce costly complications, impacting overall healthcare costs. Limited knowledge of the cost of medications coupled with the dynamic nature of prescription insurance formularies makes it difficult to ensure prescribing of cost-effective drug therapy. The objective of this study is to evaluate the impact of pharmacy benefit information availability using real-time adjudication at the point of discharge on patients’ ability to acquire and remain adherent to medications as well as the economic impact to a provider-sponsored health plan. Methods: Memorial Hermann (MH) has implemented a transmission system that provides real-time pharmacy benefit information (RTPBI) for patients at the point of prescribing within the electronic health record (EHR). A multicenter, retrospective cohort study of all covered lives under the provider-sponsored health plan treated in a MH inpatient facility from July 1, 2016 through June 30, 2017 was performed. Patients with real-time prescription benefits available through the transmission system were compared to those without to determine percentage of preferred versus non-preferred/non-formulary medications prescribed as well as the time to first/second prescription fill. Criteria for appropriate versus delayed procurement were defined. Results: The study included a total of 2,340 patients (696 patients RTPBI functionality available and 1,644 that did not at the point of prescribing at discharge). The primary analysis showed a large difference in the prescribing of preferred medications between patients who had RTPBI available at the point of care and those that did not. RTPBI significantly reduced the amount of non-preferred/non-formulary medication prescribed at the point of discharge (6.9% non-preferred/non-formulary prescribed when RTPBI was available; p < 0.001, 95% CI 0.056 – 0.111). Secondary analysis of time to first prescription fill did not show a statistical difference. However, analysis of time to second fill showed that RTPBI availability significantly impacted patients’ ability to acquire subsequent fills appropriately (69.0% versus 49.6%; p < 0.001, 95% CI 2.026 – 3.198). Conclusion: The availability of RTPBI at the point of discharge significantly reduces the prescribing of non-formulary medications. Based on the results of this study, it has the potential to improve prescribing of preferred medications. Future studies should evaluate the implications RTPBI would have on economic impact, medication adherence, and readmission rates.Item Optimizing transition of care pharmacy services by evaluating medication related readmission risk factors within the heart failure population(2022-08) Scott, Keyana N.; Tolleson, Shane R.; Zhao, Alexa; Roduta, Thomas; Hersi, MohamedBackground: Heart failure (HF) is the leading cause of hospitalization amongst patients 65 years of age and older and represents a significant clinical and economic burden. Previous studies have sought to identify risk factors associated with readmissions in HF patients. However, no studies have evaluated the medication-related risk factors that present most frequently in readmitted heart failure patients. As the medication experts, pharmacists are in a unique position to intervene and address patients’ medication related risk factors. Multidisciplinary transitions of care models have shown the positive impact on decreased readmissions within high-risk populations like HF when a pharmacist is involved in their care. A retrospective chart review of HF patients within a cardiology unit was conducted to determine medication-related risk factors within the HF patient population that can and should be prioritized for intervention by transitions of care pharmacists. Methods: Patients identified with diagnosis related groups (DRGs) for heart failure admitted to the inpatient cardiology unit of Memorial Hermann Memorial City Medical Center between January 1, 2019 to December 31st 2019 were included in this study. Two groups were evaluated: HF patients readmitted within one year of their initial admission for any reason and HF patients not readmitted within one year of their initial admission. Patients were excluded from the study if they were (1) deceased during their primary admission or (2) were discharged to hospice. Data was retrospectively analyzed based on patient information from the electronic medical record (EMR). Data points analyzed included patient demographics, date of initial admission, date to first readmission and medication-related readmission risk factors (number of medications at initial discharge, number of comorbidities, eGFR during initial admission, and length of stay at initial admission, and presence of high-risk medications at discharge including anticoagulants, antidiabetics, diuretics). Results: A total of 89 patients were included in the final analysis. No statistical significance was noted between the dependent variables and readmission status. However, variables of interest included number of medications at initial discharge and presence of anticoagulants at discharge. Results of a stepwise binomial regression did not reveal that any of the studied medication related risk factors assessed in this study were independently associated with readmission status. Discussion: Due to the lack of statistical significance in medication related readmission risk factors between the two groups, there is insufficient evidence to support that transitions of care pharmacists should prioritize any of the risk factors assessed over others. However, the results of this study does highlight the need for the involvement of comprehensively trained transitions of care pharmacists, who are able to elicit clinic reasoning and judgement in the assessment of medication related readmission risk factors present in patients. Limitations of this study include small sample size, inability to ascertain readmission status for patients readmitted external to our institution and reliance on data entered into the EMR. Conclusion: In the setting of a large community hospital, this study did not identify specific medication-related readmission risk factors in HF patients that should be prioritized over others by transitions of care pharmacists. However, this study did highlight the need for involvement of comprehensively trained transitions of care pharmacists who are able to identify HF patients at increased risk of readmission. These clinicians should place emphasis on addressing inappropriate medication therapy through discharge medication review and anticoagulant counseling while also thoroughly assessing each patient for risk factors that may present on a case-by-case basis.