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Medication Management and Adherence Education
Hospital Readmission Rates & Care Costs can be Reduced with Education

For those elderly residents that get discharged from a hosptial and move to an assisted living facility, being properly educated with regards to their medication needs is crucial to reducing the percantages of readmission back to the hospital in addition to the costs associated with the care involved from such readmission.

As hospitals and health systems move away from the old fee-for-service sick care to fee-for-value healthcare, everyone in the organization needs to have a clear understanding of how their work impacts and promotes the right care. Especially when it comes to one's medication management.

A study published in the January/February 2013 issue of the Journal of the American Pharmacists Association analyzes the critical role of pharmacists relating to proper medication education to reduce readmission. The researchers in the study found that a simple phone call from a pharmacist to a patient after discharge reduced readmission and increased the hospital's financial savings, especially for patients at high risk for readmission.

The examiners found that patients, who received medication therapy assessment and reconciliation, had decreased readmission rates at 7, 14, and 30 days post discharge. The financial savings, for the participating hospital group in the study, showed per 100 patients receiving medication reconciliation impacted an estimated $1,500,000 in savings annually. "The findings of the study support the role of pharmacist medication therapy assessment and reconciliation as a key step in the transitional care process from hospital to home," wrote the researchers.

Interview with Dr. Steve Leuck of AudibleRX

We interviewed Dr. Steve Leuck, a pharmacist and medication education expert and owner/president of AudibleRX, to get a first hand account about the role pharmacists play in medication education. Read Dr. Steve Leuck's full bio.

Read on for Dr. Leuck's thoughts on the following topics:

Proper Medication Adherence Lessens Readmission Risks and Costs

To better understand how medication adherence contributes to elderly healthcare safety, post discharge Dr. Leuck gives insight into the medical professions' knowledge and how it contributes in lessening hospital readmission. Medication adherence is one of the factors that contribute to patients' conditions worsening that can affect readmission. Medications errors are a big problem, especially for older adults.

Leuck on Discharge Planning

Pharmacists are key players on the team of health care professionals that help patients prepare for discharge from the hospital. Pharmacists are the medication experts and are in a unique position to help bridge the medication-education-gap between the patient and the tremendous amount of medical information they're compelled to learn.

Pharmacist involvement, following the patient through their transition from an inpatient to their next level of care, can help assure appropriate medication use while decreasing the opportunity for adverse medication events.

-- Dr. Steve Leuck
Pharmacist and Medication Education Expert
How Pharmacist Improve Care at Discharge

In an ideal world, each patient can to visit with a pharmacist for 30 minutes before discharge. The pharmacist would review each discharge medication with the patient; help the patient understand why they are taking it and what to look for, while also assuring the patient understands the consequences of not taking their medications.

While some facilities are able to offer this level of service, in reality, most institutions effectively and efficiently discharge patients from their hospital without the patient ever seeing a pharmacist. Many hospitals meet their discharge medication education requirement by providing a stack of drug information leaflets while an incredibly busy nurse assures the patient understands the medication orders their physician has prescribed for them to take when they get home.

There are big benefits of pharmacist participation in discharge counseling, however, many institutions are reluctant to provide the fiscal resources for an "ideal world" pharmacist based discharge education program. The facility that I work with has had some growing pains around this issue.

-- Dr. Steve Leuck
Pharmacist and Medication Education Expert
Dr. Leuck's Role in a Community Hospital

Initially we attempted an "ideal world" program where a hospital pharmacist would visit with an identified patient for 30 minutes and discuss their medication profile. While educated patients showed positive results, the time that the entire process took significantly limited the number of patients visited and the program didn't receive management approval to continue more than the three-month trial period.

After much research, discussion and planning, we've revised the program to involve our out-patient pharmacy. A thoughtful and well-designed flyer, describing our ambulatory pharmacist education and follow-up service, is part of the admission packet for each new hospital patient. Concurrently, a thorough education program, informing the nursing, medical, case management and social service staff of our program will help achieve support from the entire hospital health care team.

-- Dr. Steve Leuck
Pharmacist and Medication Education Expert
Solutions for Polypharmacy

Medication Adherence Education
Medication Adherence Education

Patients with new and/or multiple medications, or with co-existing disease states, are identified and offered the opportunity to fill their medications with our pharmacy on campus before the discharge home. Our service provides a complete medication management review with the patient and/or their caregiver in order to assure they understand their pharmaceutical regimen.

Our ambulatory care pharmacist will then follow-up with a phone call three days after discharge to trouble shoot any medication complications while assuring adherence to the patient's medication regimen. Later, at 21 days after discharge, we will call the patient again, to answer any questions while also helping the patient coordinate refills with the community pharmacy of their choice.

As of today, we have the service approved through administration, the flyers are at the printer, and we are educating the out-patient pharmacy staff as to how the program will be implemented and monitored. We look forward to complete implementation within the next month.

-- Dr. Steve Leuck
Pharmacist and Medication Education Expert


Researchers from the 2013, Journal of the American Pharmacists Association study, established that collaboration and engagement with patients, families, and caregivers, plays a big role in medication adherence.

There's a huge difference between what the patient hears and what a family member hears. But collaboration should always include health care providers, and community networks to enhance a successful discharge and care transition.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.