2026 Southeastern Residency Conference

EVALUATION OF MEDICATION ACCESS INTERVENTIONS BY TRANSITIONS OF CARE PHARMACIST FOR PATIENTS REQUIRING HIGH-COST CARDIAC MEDICATIONS  
Esther Cho, Alexandra Cooper, Laura Provost, Nathan Wayne, Maegan Whitworth Wellstar MCG Health – Augusta, GA 
Background/Purpose: Centers for Medicare and Medicaid Services (CMS) monitors 30-day readmission rates per the CMS Hospital Readmission Reduction Program based on relative conditions or procedures including acute myocardial infarction (AMI), heart failure (HF), and coronary artery bypass graft (CABG). These three conditions have a high readmission rate per the CDC 2021 national data, with HF having the highest readmission rate at 22% (AMI 16% and CABG 13%). Current studies show TOC interventions, by a multidisciplinary team, lower 30-day readmission, but there is no literature focusing on an exclusive pharmacist-led intervention, with a specific focus to medication access such as medication affordability. n these studies, since most hospitals do not have a dedicated Transitions of Care (TOC) pharmacists, “standard of care” is considered to be general patient care, whereas TOC interventions are established to ensure continuity and coordinate care to patients. Therefore, further evaluation is required to evaluate the effectiveness and impact of pharmacist-led TOC intervention.

Methodology: This is a retrospective chart review of adult patients who were discharged from a cardiac floor with high-cost cardiac medications (e.g. Eliquis, Entresto, Jardiance) between November 4, 2024 – May 31, 2025. Interventions made by a non-TOC pharmacist, pregnant patients, and prisoners were excluded in this study. The primary outcome is overall 30-day readmission rate. Secondary outcomes include quantification and classification of TOC pharmacy interventions, patient assistance applications initiated and/or approved, percentage of prescriptions filled at discharge, and 30-day readmission cause.

Results: Overall, 186 patients were included in the pharmacist-led TOC intervention group and 79 patients were included in the non-TOC intervention group. No significant difference was observed in rate of readmission within 30 days of discharge between TOC intervention and non-intervention groups (24% vs 20%, p=0.62). However, higher percentage of patients in the intervention group filled new high cost medication prescriptions at discharge (60% vs 47%, p=0.30), more medications were prescribed to meds-to-beds pharmacy (47% vs 32%, p=0.22), and patients in the TOC intervention group were less likely to be readmitted for medication related events (2% vs 12%, p=0.11).

Conclusions: No difference was observed in overall 30-day readmission rate between pharmacy-led TOC intervention group vs non-TOC intervention group. More providers prescribed new high-cost medications to Wellstar MCG Meds-to-Beds pharmacy, and a higher percentage of new prescriptions were dispensed at discharge with TOC pharmacist intervention. Additionally, patients were less likely to be readmitted for medication-related events in the TOC intervention group.

Title: Pharmacist Led COPD Medication Recommendations During Discharge Medication Review

Authors: Bridget Arellano, Ali Diaz, Dahlia Kaiser
AdventHealth Orlando, Orlando, FL

Background/Purpose: Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity, with national 30-day readmission rates near 30%. To reduce rates of readmission, the Center for Medicare and Medicaid Services (CMS) implemented a Hospital Readmission Reduction Program, incentivizing improved communication and coordination for patients at discharge. Currently our COPD readmission rate is approximately 20%. To address this, our hospital initiated a pharmacist-led discharge medication reconciliation (DMR) workflow to optimize COPD therapy with a goal to maintain readmission rates below 16%. However, the clinical reach of this program and the rate of provider acceptance of these recommendations is not well established. This study aimed to evaluate physician acceptance of pharmacist-driven COPD therapy recommendations and its association with 30-day readmission rates.

Methods: This retrospective chart review included patients ≥65 years of age with COPD, discharged home from AdventHealth Orlando between January and September of 2025. Data collected included demographics, pharmacist interventions, recommendation types, provider response, and 30-day readmission outcomes. Descriptive statistics were used to evaluate intervention frequency, acceptance rates, and readmission outcomes.

Results: A total of 168 patient encounters and 119 unique patients were analyzed. Pharmacist interventions were made in 14 (8.3%) patient encounters, and the majority (n=10; 71.4%) were to recommend adding an additional agent to the patient’s current regimen. Of the 14 pharmacist interventions, 9 (64.3%) were accepted by the provider. Overall, 30-day readmissions occurred in 22 (18.5%) patients and 59 (35.1%) encounters. Out of the nine encounters with accepted interventions, 4 (44.4%) had a 30-day readmission. Due to the low intervention rate, comparative analysis between accepted and non-accepted recommendations was limited.

Conclusions: Pharmacist interventions during discharge medication reconciliation were very limited in this dataset of elderly patients with COPD. Although readmission rates in this specific population remained above goal, the low number of interventions restricts conclusions regarding the impact of recommendation acceptance on patient readmission rates. Future efforts should focus on the DMR workflow and evaluate various barriers surrounding pharmacist interventions on optimizing COPD therapy.