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Phone: (843) 722-7550
West Ashley Library
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Folly Beach Library
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Edgar Allan Poe/Sullivan's Island Library
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Wando Mount Pleasant Library
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Village Library
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Reducing hospital readmission through team-based primary care: A 7-week pilot study integrating behavioral health and pharmacy.
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- Author(s): DeCaporale-Ryan, Lauren N.; Ahmed-Sarwar, Nabila; Upham, Robbyn; Mahler, Karen; Lashway, Katie
- Source:
Families, Systems & Health: The Journal of Collaborative Family HealthCare. Jun2017, Vol. 35 Issue 2, p217-226. 10p. - Source:
- Additional Information
- Subject Terms:
- Subject Terms:
- Abstract:
Introduction: A team-based service delivery model was applied to provide patients with biopsychosocial care following hospital discharge to reduce hospital readmission. Most previous interventions focused on transitions of care occurred in the inpatient setting with attention to predischarge strategies. These interventions have not considered psychosocial stressors, and few have explored management in primary care settings.Method: A 7-week team-based service delivery model was implemented in a family medicine practice emphasizing a biopsychosocial approach. A physician, psychologist, pharmacist, care managers, and interdisciplinary trainees worked with 17 patients following hospital discharge. This comprehensive evaluation assessed patients' mood, cognitive abilities, and self-management of health behaviors. Modifications were made to improve ease of access to outpatient care and to improve patient understanding of the therapeutic plan. This pilot study was conducted to determine the utility of the model.Results: Of 17 patients, 15 individuals avoided readmission at 30- and 90-day intervals. Other substantial benefits were noted, including reduced polypharmacy, engagement in specialty care, and reduction of environmental stressors to improve access to care. The clinic in which this was implemented is currently making efforts to maintain this model of care based on observed success.Discussion: Although this work only represents a small sample, results are encouraging. This model can be replicated in other primary care settings with specialty clinicians on site. Specifically, approaches that promote a team-based delivery in a primary care setting may support improved patient outcomes and reduced overall systems' costs. Recommendations for research in a clinical setting are also offered. (PsycINFO Database Record [ABSTRACT FROM AUTHOR] - Abstract: Copyright of Families, Systems & Health: The Journal of Collaborative Family HealthCare is the property of American Psychological Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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