Hospital readmissions, a $17 billion annual problem, are higher in rural, remote or smaller communities that sometimes have significantly less access to pharmacies, according researchers who are among the first to examine this issue.

Researchers at Oregon State University (OSU) and Oregon Health & Science University (OHSU) found that the average number of readmissions in rural areas was higher compared with their urban counterparts (15.3% vs. 14.7%) where the days and hours a person could find an open pharmacy were much higher.

“It’s a huge burden both on a patient and our medical system when they have to be readmitted to a hospital,” said David Lee, PharmD, PhD, an assistant professor at the OSU and OHSU Colleges of Pharmacy, in Corvallis and Portland.

“The modern pharmaceutical profession is increasingly being recognized as an important partner in health care, and as its services continue to expand it will help even more. This research shows that pharmacy access can help people from going back to the hospital. For older populations who often find hospital experiences quite exhausting, that’s extremely important to their overall health.

“The sooner a person gets out and stays out of a hospital, the better off they usually will be,” he said.

U.S. hospitals are penalized by federal payors for unplanned hospital readmissions. It can be a problem with various groups: older adults; people who have several medical conditions; those taking multiple medications; and people who have difficulty adhering to their medication regimens.

The study was done in Oregon with census data of patients older than 65 years of age, studying 507 pharmacies and 58 hospitals. It was supported by the OHSU Layton Aging & Alzheimer’s Disease Center, which is funded by the National Institutes of Health.

In some rural areas of Oregon, Dr. Lee noted, a person might have to drive 100 miles or more to find a pharmacy. In one of Oregon’s rural communities there is a single pharmacy that’s open 54 hours a week; by comparison, in some major urban areas a person might be able to find multiple pharmacies that collectively are open more than 3,800 hours a week.

These challenges of availability, distance and convenience to professional pharmaceutical products, service and counsel are a problem, the researchers said. Another interesting corollary to the issue, they said, is identification of what have been called “pharmacy deserts” even within major urban areas, such as Chicago.

“Large, urban, predominantly white communities usually have a lot of pharmacies and access,” said Sarah Bissonnette, an OSU postdoctoral fellow. “But in some lower socioeconomic areas even within cities, it’s much more difficult to find an open pharmacy.”

Health-system pharmacists can help improve these statistics, they said. Improved hospital discharge medication counseling has been shown to increase adherence to use of new or changed medications, the study indicated. And some hospitals around the country have also taken it upon themselves to open outpatient, community and 24-hour pharmacies to reduce readmission rates.

“Pharmacy-led initiatives have included performing medication reconciliation and discharge medication counseling at the patient’s bedside. Discharge medication counseling has shown to increase adherence to new medications and medication changes made at hospital discharge,” the researchers wrote.
Nonadherence to medication usage ranges from 25% to 50% in the United States, depending on the disease state, and is associated with increased illness and death, the study noted. Causes can include adverse side effects, insurance coverage, costs, education levels, cognition and pharmacy access.

“The scope of pharmacy is evolving,” they said. “Oregon has recently recognized pharmacists as health care providers, and a survey in 2012 found that inpatient pharmacist monitoring increased from 20.3% in 2000 to 46.5% in 2012.”

If more conventional pharmacies are not economically viable, the researchers said, a possible remedy to the problem is growth and improvement of telepharmacy or mail-order services that are carefully backed up by personal advice, monitoring and counsel from professional pharmacists.

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