Linkage to Hospital Pharmacy for Rifaximin Receipt Prior to Discharge from Hospitalization with Hepatic Encephalopathy Reduces Early Readmissions in Patients with Liver Cirrhosis: A Quality Improvement Project

Background and Aims: Hepatic Encephalopathy (HE) leads to multiple hospitalizations in liver cirrhosis. This imposes a significant burden on patients caregivers, and the healthcare system. Rifaximin reduces HE recurrence and hospitalizations, but many patients are not able to receive Rifaximin promptly after hospitalizations due to gaps in the prior authorization process and insurance coverage. This study shows the results of the Quality Improvement (QI) project aimed at improving access to Rifaximin by utilization of hospital pharmacy to provide Rifaximin at bedside or soon after hospital discharge with HE. Methods: A retrospective analysis of 124 patients admitted to our hospital with recurrent HE was performed. All selected patients had Rifaximin prescribed for the first time during a hospitalization (index hospitalization). Both 30-day and 60-day liver-related hospitalizations were recorded for these patients. 80 patients were included in the intervention group when the hospital pharmacy was notified of the Rifaximin prescription prior to discharge as part of a QI project (Group A). Control (Group-B) group included 44 patients who had admission and were prescribed Rifaximin at discharge, prior to initiation of our QI project. Results: The number of patients who had a re-admission after index hospitalization with HE was lower in Group A compared to Group B (48% vs 73%, p=0.002 for re-admission within 30 days; 56% vs 73%, p=0.007 for re-admission within 60 days respectively). Total hospitalizations decreased in Group A (reduced by 32%, and 59% for the 30-day and 60-day time frame, respectively) compared to Group B. The median days to readmission in Group A was 32, compared to 10 in Group B after the index hospitalization. Conclusion: Providing Rifaximin to patients with recurrent HE before or soon after discharge from HE-related hospitalization reduced readmission rates for liver-related admissions at our hospital. A significantly higher number of patients did not require early readmission when Rifaximin was provided by the hospital pharmacy. This intervention could lead to lower costs, fewer complications related to frequent hospitalization, and thus reduced healthcare burden.