• Susan P Bell, Jeffrey L Schnipper, Kathryn Goggins, Aihua Bian, Ayumi Shintani, Christianne L Roumie, Anuj K Dalal, Terry A Jacobson, Kimberly J Rask, Viola Vaccarino, Tejal K Gandhi, Stephanie A Labonville, Daniel Johnson, Erin B Neal, Sunil Kripalani, and Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) Study Group.
• Vanderbilt Center for Translational and Clinical Cardiovascular Research (VTRACC), Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Suite 300-A 2525 West End Avenue, Nashville, TN, 37232-8300, USA. susan.p.bell@vanderbilt.edu.
• J Gen Intern Med. 2016 May 1; 31 (5): 470-7.

BackgroundReduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal.ObjectiveThe aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge.DesignRandomized, controlled trial with concealed allocation and blinded outcome assessorsSettingTwo tertiary care academic medical centersParticipantsAdults hospitalized with a diagnosis of ACS and/or ADHF.InterventionPharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after dischargeMain MeasuresThe primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported.Key ResultsA total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition.ConclusionA tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.

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