Diabetes Care in A Safety Net Hospital: Impact of a Pharmacist Transitional Care Service.

Abstract

Background: Diabetes is associated with increased risk of hospital readmission and imposes a significant economic burden on patients and healthcare systems. Literature suggests that pharmacist-led transitions-of-care (TOC) services reduce hospital readmissions and improve patient outcomes and data within safety-net hospitals is limited. Methods: This was a single-center evaluation to assess the impact of pharmacist-led diabetes TOC services on hospital readmissions among diabetes patients vs standard care (SC). The evaluation included patients admitted from 11/1/2021-2/28/2022 and 10/19/2022-2/28/2023 who had a primary diagnosis of diabetes mellitus, were admitted for a diabetes-related reason, or were seen by the endocrine consult service during admission. The primary outcome was 30-day readmissions. Secondary outcomes included time to readmission, readmission diagnosis, changes in HbA1c, completion of follow-up visits, and number of pharmacist interventions at follow-up. Results: There were 109 patients included (TOC n = 65; SC n = 44) and 13.8% (9/65) of TOC and 18.2% (8/44) of SC patients readmitted within 30 days (P = .235). Average time to readmission was 15.3 days in the TOC and 10.4 days in the SC cohorts. There were no diabetes-related readmissions in the TOC cohort. Over 60% (5/8) of readmissions in the SC cohort were diabetes-related. The average change in HbA1c was -2.5% in the TOC cohort and -1.2% in the SC cohort, P = .046. Approximately 51% of TOC patients completed an outpatient follow-up visit and nearly 70% of those patients had an intervention made at that time. Conclusion: Pharmacist-led diabetes TOC services within a safety-net hospital may reduce hospital readmissions and improve clinical outcomes.