Evaluation of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for People With Heart Failure

Abstract

Medication-related problems (MRPs) are common during transitions of care for people with heart failure (HF), contributing to early hospital readmission and mortality. However, the integration of a nurse-pharmacist model of care (MoC) into transitional care has seldom been explored. To determine the feasibility and acceptability of a nurse-pharmacist transition-of-care telehealth service for patients with HF discharged from the John Hunter Hospital, Australia. We also explored the impact of service provision on MRP detection, guideline-directed medical therapy (GDMT) prescribing, and hospital readmissions. Upon discharge, patients with HF were referred to an existing telehealth service and offered pharmacist-led medication reconciliation and education ("MedRec") in addition to usual care. Primary outcomes were feasibility, measured by recruitment and successful MedRec completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were MRPs detected during MedRec. Exploratory outcomes included GDMT prescribing and hospital readmission rates. A total of 100 patients with HF were offered MedRecs and accepted by 80 patients. In total, 62 MedRecs were performed, mean age 67.6 (±13.6) years, male sex (n=34/62; 54.8%). MRPs detected included: 25 recipients (40.3%) experiencing drug-related toxicity or adverse events, 13 recipients (20.9%) experiencing medication non-adherence issues, and 12 recipients (19.4%) with drug optimisation issues unrelated to their HF. Drug and/or disease management information was requested by 35 MedRec recipients (56.4%). Post-MedRec, 56.5% of participants completed surveys. Engagement with a pharmacist via MedRec enhanced medication education, was perceived to ease anxiety associated with understanding medication-related changes, and empowered greater self-management. GDMT optimisation was recommended for over two-thirds (69.2%) of MedRec conducted for HF with reduced ejection fraction patients. The rate of 30-day cardiovascular readmissions was reduced by nearly 8% for those who accepted a post-discharge MedRec compared to those who declined the MedRec service (8.1% (n=5/62) vs 15.8% (n=6/38) respectively, [p=0.324]). A post-discharge nurse-pharmacist telehealth service is a feasible and well-accepted MoC. The inclusion of a routine MedRec post-discharge may enhance continuity of care, improve medication safety, and support HF management.