For the last ten years, the readmission number regarding the thirty-day increase in the United States of America, and has been especially with acute myocardial infarction (AMI). Furthermore, the increase in number also applies to decompensated heart failure. Furthermore, the risk-standardized mean rate for the readmission has also been reported to be at 19.9% for the AMI and at 24.6% for the ADHF (Bell et al, 2016). On the other hand, the cost of an increased 30-day readmission rate has been attributed to such factors as the limited information on the effectiveness of the payment penalties and the intervention. It has been reported that when patients shift to their homes after they experienced the readmission, they tend to face a lot of challenges which range from complex medical environments. However, such environments are important for ensuring that they achieve stability which eventually enables them to improve their medical conditions.
Furthermore, some of the complications which the patients encounter after going to their homes from the hospital include drug allergies, non-adherence to the drug medication instructions, and also discrepancies that may require one to be readmission to the hospital as well. Additionally, it has also been noticed that patients that have cognitive impairment or low health literacy can also risk being readmitted to the hospital since they might be struggling to manage the medication conditions something that might be difficult for them (Bell et al, 2016). Therefore, the current study has been carried out to investigate whether the pharmacist intervention can have an effect on the low literacy groups and the healthcare utilization after an individual has been discharged from the hospital. Furthermore, the study is also important in that it investigates the weather impact had differences regarding the literacy and the patients’ cognitive status.
The aim of the research is to come up with the effects of the pharmacist-dispensed health literacy intervention on the use of healthcare after an individual has been discharged from the hospital. The impacts could also involve hospital readmission, and Emergency Room (ER) visits.
Design of the Study
During the study, the control trials were randomly executed in two varied academic institutions. These institutions were the Brigham and Women's Hospital (BWH) in Boston, Massachusetts, and Vanderbilt University Hospital (VUH) in Nashville. The approval of the study was done by the Partners Human Research Committee and the Vanderbilt University Institution Review Board (Bell et al, 2016). Furthermore, the trial was signed up randomly for the provision of care and intervention where they encountered an evaluation after a period of 30 days after the discharge. The respondents were then recruited in the programs of the hospital between May of 2008 and September of the year 2009 (Bell et al, 2016). During the study, patients above the age of 18 years and who had been diagnosed with ACS were included in the program. Furthermore, those patients who were diagnosed with acute decompensated heart failure (ADHF) but above 18 years were also included in the program (Bell et al, 2016).
These conditions were important for ensuring that the study is executed in a manner that will reflect the reality of the situation. Furthermore, during the study, those who were excluded also were patients who had a cognitive impairment which included those with advanced or moderate dementia (Bell et al, 2016). The other criteria that were also used included the patients with altered mental status or even those who had unstable psychiatric conditions. Additionally, those patients who were under hospice care and those who were too weak to undertake the interview were also excluded (Bell et al, 2016). Furthermore, the patients who were unable to speak English or Spanish were also not included in the study. The study also excluded the patients who were enrolled in various medical examination programs, and those patients who were about to be discharged from the hospital were also not included in the program.
The study was important because it facilitated the recruitment of the respondents who could take place in the interview. Additionally, it employed the next avert possible biases to ensure orderly recruitment of the patients on day by day basis. After the completion of the enrollment program and also the follow-ups, the study was terminated and this allowed for choosing of the sample (Bell et al, 2016).
The study used the primary analysis which enabled the evaluation of time with respect to the composite outcome. Additionally, the statistics were executed by the intention-to-treat, and this was important for establishing the sizeable sample. However, those who were not willing to take part in the interview were left. The errors encountered during the study were regarded as the primary outcome and were important during the clinical context. The primary outcome of the patients was seen to be a detection of 30%, and the evaluation of the statistics was executed with the use of the regression models (Bell et al, 2016). This was important for the determination of the link between the intervention and the time of the first unplanned experience of the healthcare. Also, the cumulative incidence plots were also established by taking into consideration such factors as sex, age, marital status, number of medications, type of insurance, the diagnosis, and also the risky score. Furthermore, the study also utilized the statistical data evaluation which was significant for eliminating different case records. The research assumed a significance of 5% confidence level (Bell et al, 2016).
Why Is Health Literacy Important?
Out of the 862 patients who were randomized for the interview only 851 of them were enrolled. Those who were placed under usual care were 428 patients while those who were placed under intervention were 423. The patients' demographic table revealed the median to be 60 years. On the other hand, 59% of the patients were male while 41% were female (Bell et al, 2016). Additionally, 10% were found to have inadequate health literacy were 9% of them had marginal health literacy (Bell et al, 2016). The study also found out that 81% of the patients had adequate health literacy. What is more, the study found out that out of the interviewed patients, 61% were suffering from ACS condition (Bell et al, 2016).
After a month since the patients were discharged, 189 of them were found to have attained the primary compounded outcome of the time to seek medical care. Out of the 189 patients, 97 of them were on the intervention program while 92 of them were on the unusual-care (Bell et al, 2016). Thus, the adjusted HR was found to be 1.04 i.e. 95% C 0.78-1.39 (Bell et al, 2016).
In the secondary outcome, the ER visits were found to have not registered any hospital readmission, and thus there was no difference in the statistical significance between the control groups and also the intervention groups. Furthermore, the adjusted HR and the Emergency Room visits were found to be 1.03 i.e. 95% CI 0.76-1.39 (Bell et al, 2016).
The other results of the study also showed that having medical literacy is important as it influences the effects of treatment. For example, it was found that with patients that had inadequate health literacy, the intervention and unplanned healthcare utilization went down. However, there was no influence of cognitive status on the treatment in the intervention programs (Bell et al, 2016).
It was concluded by the study that the primary outcome of the initial readmission and the ER visits were fairly constant. Furthermore, it was also concluded that the intervention programs are important for reducing the unplanned utilization of healthcare for those individuals who do not have adequate health literacy (Bell et al, 2016).
Strengths of Intervention Programs
The intervention is necessary because it provides counseling to the patients in a way that was friendly and produces low literacy in health. The response is also important because it seeks to fill a knowledge gap which increases the results of the study population.
Limitations of Intervention Programs
Some limitations could be seen in the changes regarding the medication errors and mishaps or resulting healthcare. Furthermore, the use of non-clinical personnel also resulted in the limitation of the researchers’ intervention.
There were also insufficient post-discharge providers and intervention programs.
There was also the unscheduled seeking of medical care after the discharge of an individual.
Application in a Clinical Context
The research is important to the United States of America as it provides knowledge for bringing down the post-discharge rate that has been high. It is also important for revealing the customized pharmacist-dispensed literacy-dependent intervention which is effective for treating patients with inadequate medical literacy. It is revealed that it is important to have a high number of pharmacists to focus on the target population. The research is also essential for showing the significance of pharmacists’ intervention in the hospitals and those who are discharged in specific populations.
Funders of the Article
It was founded in the form of the graph by the R01 HL989755 (SK) and K23 HL077597 (SK).
It was also funded by the National Heart, Lung and Blood Institute (K08 HL072806 (JS) 2K24 HL077506 (VV))
Furthermore, it was funded by the (Bell and Colleagues) who were backed by the K12HD043483-11 courtesy of NIH/NICHD
It also sourced the finances from the Einstein Women Heart Fund.
Bell, Susan P., et al (2016). "Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial." Journal of General Internal Medicine, vol. 31, no. 5, pp. 470-477.
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