The Impact of Clinical Pharmacist Tele-follow-up on Diabetic Patient’s Readmission Due to Reinfection of Methicillin-Resistant Staphylococcus Aureus (MRSA) in Iraqi Patients


  • kawthar faris Ministry of Health and Environments, Baghdad, Iraq
  • Besmah M.Ali Ibrahim Ministry of Health and Environments, Baghdad, Iraq
  • Osama Zuhair Salman Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
  • Zainab Jumaa Qasim Baghdad College of Medical Sciences, Baghdad, Iraq
  • Ameer A oudah Ministry of Health and Environments, Baghdad, Iraq
  • Aaya Ayad Okab Ministry of Health and Environments, Baghdad, Iraq
  • Jawad K.Aldiwan Department of Community, Baghdad College of Medicine, University of Baghdad, Baghdad, Iraq



pharmacist tele follow-up , diabetic patients , MRSA



There are many risk factors significantly associated with readmission of diabetic patients after discharge  like surgical site reinfection with methicillin-resistant Staphylococcus aureus which has been demonstrated to be associated with more amputations, longer hospitalization , increase healthcare costs and increased mortality .This study was to describe the impact of clinical pharmacist tele-follow-up on diabetic patient’s readmission due to reinfection of methicillin-resistant Staphylococcus aureus, rate of referral to inpatients team and, return visits to the emergency department, 203 patients who were randomized into two groups. Group A (interventional group) 103 patients and group B (control group) 100patients who are discharge from hospital after diabetic foot amputation. The primary endpoint was the reduction in the readmission due to reinfection by methicillin-resistant Staphylococcus aureus, reduce the referral to in patients team and fewer return to the emergency department. there was significant differences between the two groups in rates of readmission, referral to their inpatients team, and return visits to the emergency department with (P-value =0.004,  0.00017 ,and0.002 ) respectively. Conclusion the pharmacist tele-follow-up was associated with decrease in rates of readmission, fewer referrals to in patients team and decrease in return visits to the emergency department.


Keywords: pharmacist tele follow-up , diabetic patients , MRSA



Author Biographies

  • Besmah M.Ali Ibrahim, Ministry of Health and Environments, Baghdad, Iraq

    Department of public health  

  • Osama Zuhair Salman, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq

    Department of medicine

  • Zainab Jumaa Qasim, Baghdad College of Medical Sciences, Baghdad, Iraq

    Baghdad college of medical scinces


Oscalices MI, Okuno MF, Lopes MC, Campanharo CR, Batista RE. Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial. Revista latino-americana de enfermagem. 2019 Aug 19;27.

Alper E, O’Malley TA, Greenwald J, Aronson MD, Park L. Hospital discharge and readmission. UpToDate. Waltham, MA: UpToDate. 2017.

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine. 2009 Apr 2;360(14):1418-28.

Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Annals of internal medicine. 2011 Oct 18;155(8):520-8.

Ravn-Nielsen LV, Duckert ML, Lund ML, Henriksen JP, Nielsen ML, Eriksen CS, Buck TC, Pottegård A, Hansen MR, Hallas J. Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission: a randomized clinical trial. JAMA internal medicine. 2018 Mar 1;178(3):375-82.

Piper K, DeAndrea-Lazarus I, Algattas H, Kimmell KT, Towner J, Li YM, Walter K, Vates GE. Risk factors associated with readmission and reoperation in patients undergoing spine surgery. World neurosurgery. 2018 Feb 1;110:e627-35.

Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, Harbarth S. Methicillin-resistant Staphylococcus aureus. Nature reviews Disease primers. 2018 May 31;4(1):1-23.

Bhattacharya S, Pal K, Jain S, Chatterjee SS, Konar J. Surgical site infection by methicillin resistant staphylococcus aureus–On decline?. Journal of clinical and diagnostic research: JCDR. 2016 Sep;10(9):DC32.

Demoz GT, Wahdey S, Bahrey D, Kahsay H, Woldu G, Niriayo YL, Collier A. Predictors of poor adherence to antidiabetic therapy in patients with type 2 diabetes: a cross-sectional study insight from Ethiopia. Diabetology & Metabolic Syndrome. 2020 Dec;12(1):1-8.

Owens DR, Monnier L, Barnett AH. Future challenges and therapeutic opportunities in type 2 diabetes: C hanging the paradigm of current therapy. Diabetes, Obesity and Metabolism. 2017 Oct;19(10):1339-52.

Bain SC, Cummings MH, McKay GA. Multidisciplinary Approach to Management and Care of Patients with Type 2 Diabetes Mellitus. DIABETES. 2019 Nov.

Pyatak EA, Sequeira PA, Whittemore R, Vigen CP, Peters AL, Weigensberg MJ. Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with type 1 diabetes. Diabetic Medicine. 2014 Dec;31(12):1615-24.

Preslaski CR, Lat I, MacLaren R, Poston J. Pharmacist contributions as members of the multidisciplinary ICU team. Chest. 2013 Nov 1;144(5):1687-95.

Yang S. Impact of pharmacist-led medication management in care transitions. BMC health services research. 2017 Dec;17(1):1-8.

Braun E, Baidusi A, Alroy G, Azzam ZS. Telephone follow-up improves patients satisfaction following hospital discharge. European journal of internal medicine. 2009 Mar 1;20(2):221-5.

Alper E, O’Malley TA, Greenwald J, Aronson MD, Park L. Hospital discharge and readmission. UpToDate. Waltham, MA: UpToDate. 2017.

Kim H, Ross JS, Melkus GD, Zhao Z, Boockvar K. Scheduled and unscheduled hospital readmissions among diabetes patients. The American journal of managed care. 2010 Oct;16(10):760.

Hoffman GJ, Liu H, Alexander NB, Tinetti M, Braun TM, Min LC. Posthospital fall injuries and 30-day readmissions in adults 65 years and older. JAMA network open. 2019 May 3;2(5):e194276-.

Watkins RR. Preventing Readmissions and Optimizing Outcomes for Staphylococcus aureus Bacteremia: Still a Long Journey Ahead. Infectious Disease Alert. 2020;39(4).

Mistiaen P, Francke AL, Poot E. Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC health services research. 2007 Dec;7(1):1-9.

Mistiaen P, Poot E. Telephone follow‐up, initiated by a hospital‐based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane database of systematic reviews. 2006(4).

Haynes KT, Oberne A, Cawthon C, Kripalani S. Pharmacists' recommendations to improve care transitions. Annals of Pharmacotherapy. 2012 Sep;46(9):1152-9.

Harrison PL, Hara PA, Pope JE, Young MC, Rula EY. The impact of postdischarge telephonic follow-up on hospital readmissions. Population health management. 2011 Feb 1;14(1):27-32.

March KL, Peters MJ, Finch CK, Roberts LA, McLean KM, Covert AM, Twilla JD. Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions. Journal of Pharmacy Practice. 2020 Sep 18:0897190020958264.

Budlong H, Brummel A, Rhodes A, Nici H. Impact of comprehensive medication management on hospital readmission rates. Population health management. 2018 Oct 1;21(5):395-400.

Sanchez GM, Douglass MA, Mancuso MA. Revisiting project re‐engineered discharge (RED): the impact of a pharmacist telephone intervention on hospital readmission rates. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2015 Sep;35(9):805-12.

Sarangarm P, London MS, Snowden SS, Dilworth TJ, Koselke LR, Sanchez CO, D’Angio R, Ray G. Impact of pharmacist discharge medication therapy counseling and disease state education: Pharmacist Assisting at Routine Medical Discharge (project PhARMD). American Journal of Medical Quality. 2013 Jul;28(4):292-300.

Fortis S, Weinert C, Bushinski R, Koehler AG, Beilman G. A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details. Journal of the American College of Surgeons. 2014 Oct 1;219(4):676-83.

Gholizadeh M, Delgoshaei B, Gorji HA, Torani S, Janati A. Challenges in patient discharge planning in the health system of Iran: A qualitative study. Global journal of health science. 2016 Jun;8(6):168.

Farris KB, Carter BL, Xu Y, Dawson JD, Shelsky C, Weetman DB, Kaboli PJ, James PA, Christensen AJ, Brooks JM. Effect of a care transition intervention by pharmacists: an RCT. BMC health services research. 2014 Dec;14(1):1-3.