2012 Awardee: Boston VA Healthcare System

The PILL Service: Enhancing Medication Safety after Hospital Discharge

Older adults, especially those with cognitive impairment, are at greater risk for medication safety issues after hospital discharge. Pilot work at the VA Boston Healthcare System (VABHS) found that inadequate and inaccurate discharge medication documentation was common. The VABHS Pharmacological Intervention in Late Life (PILL) Service was designed as a post-hospital discharge medication safety net for this vulnerable patient population. The goal of the program is to reduce acute care visits and readmissions by identifying and resolving medication problems and discrepancies during PILL calls and PILL clinic visits. The program has a broad scope that extends throughout the health system and includes multiple components of the medication-use process. The PILL Service is led by pharmacists who developed the program and provide clinical care.

Medication reconciliation activities, which align with Joint Commission National Patient Safety Goals and Veterans Affairs Directives, are at the center of the care provided through the PILL Service. Patients who are 65 years old or older, have evidence of cognitive impairment, and who are discharged directly home after an inpatient stay are eligible to participate in the program. A pharmacist proactively conducts medication reviews and follow-up calls once the patients return home. This comprehensive review includes evaluation for potential medication-related problems, inappropriate prescribing, and medication discrepancies. The pharmacist engages patients and caregivers in a dialogue that centers on performing medication reconciliation and education. Post-discharge medication changes and the patients’ ability to manage their medications are the focus of the PILL call. Patients with complex medication needs can be scheduled in the outpatient PILL clinic where pharmacists conduct patient interviews and obtain medication histories, collaborate with geriatricians to develop treatment plans, and oversee patient follow-up and monitoring.

The PILL Service has been associated with decreased use of health-system resources. In patients who received a PILL call (n=249) compared to those who did not receive this level of care (n=66), there was a reduction in emergency/urgent care usage, hospital readmission, and death. These negative outcomes were present in 57 percent of patients who received the call and 74 percent of patients who did not receive the call (p<0.01). In adjusted analyses, PILL calls significantly reduced combined negative outcomes by 24 percent (adjusted RR 0.76, 95 percent CI 0.58, 0.98). In 2011 a $312,000 cost avoidance, which supports program sustainability, was associated with the PILL Service.

Through the PILL Service, a pharmacist-led interdisciplinary approach has been effective in addressing patients’ medication problems and reducing negative outcomes, such as hospital readmissions and emergency department/urgent care visits.

Multidisciplinary Team
Allison M. Paquin, Pharm.D., Team Chair
Elizabeth Archambault, LISCW
Mary Beth Harrington, N.P.
Brittany Kelly
Karyn Lawrence
James Rudolph, M.D.
Marci Salow, Pharm.D.