Presentation (CTI)

OBJECTIVES: Rifaximin, recommended for lactulose-refractory hepatic encephalopathy (HE), has been shown to reduce HE-related hospitalizations and healthcare costs. In July 2021, a pilot outpatient rifaximin access service was launched to assist patients and secure financial support for rifaximin prior to discharge. The pilot, initially managed by multiple teams, was streamlined under a single group in October 2023. This study aims to evaluate the impact of outpatient clinical pharmacy (OCP)-driven access to rifaximin on 30-day readmission rates among hospitalized patients with HE initiated on rifaximin.
METHODS: This longitudinal, retrospective study included patients aged ≥18 years admitted with a primary diagnosis of HE and received inpatient rifaximin between January 2020 and October 2024. An interrupted time series design was used to evaluate the effect of the OCP-driven service on 30-day readmissions after two intervention periods which included the original pilot (July 2021) and program workflow updates (November 2023). Patients were assessed for 18 months before the first intervention, 28 months after the first intervention, and 12 months after second intervention.
RESULTS: A total of 396 unique OHE patients received inpatient rifaximin during the study period. Monthly eligible patients averaged 7 (SD = 3), with a median (IQR) of 7.5 (4). Mean (SD) monthly 30-day readmission rates were 29% (11.2%) before implementation, compared to 37% (27%) during the first intervention period and 26% (23%) during the second intervention period. The only significant finding was observed after the second intervention, which was associated with a subsequent 23% monthly decrease in the odds of readmission (OR = 0.77, 95% CI 0.62-0.95, P = 0.0141).
CONCLUSIONS: Following process streamlining, OCP-driven rifaximin access was associated with significantly decreasing rifaximin readmissions.