An intervention that includes pharmacist-led transitions of care (TOC) can significantly reduce readmissions, according to the results of recent research.1 Investigators found people enrolled in a pharmacist-led TOC clinic experienced significantly lower rates of 30-day and 90-day readmissions when compared to those without the intervention.
“The purpose of this study was to implement transitions of care services that our pharmacy led to decrease readmissions,” says Maria Parodi, PharmD, CPH, clinical pharmacist in the department of pharmacy at Sarasota (FL) Memorial Hospital. At the time of the study, Parodi was a resident at Health First Holmes Regional Medical Center.
Pharmacists and pharmacy residents worked in the TOC clinic Monday-Friday, 12 p.m. to 4 p.m. They called patients and provided follow-up.
The first phone call was to ensure medication reconciliation was complete and to review the discharge medications with the patient. If patients ask questions, suggesting they cannot afford a particular medication, the pharmacist will contact their primary care physician or other prescriber to see if they could switch the prescription to a cheaper alternative.
At first, the pharmacy residents/pharmacists educated patients and performed medication reconciliation via phone. Later, they also conducted video conferences and emailed visual instructions as needed, says Brekk Feeley, PharmD, CPH, DPLA, MA, lead clinical pharmacy specialist at Health First Holmes Regional Medical Center in Melbourne, FL.
Medication reconciliation is important at all steps of the care continuum. If patients are sent home with specific medications prescribed during their hospital stay, there is no guarantee they will continue those medications, or that they will not return to using their older prescription drugs, which are no longer safe for them.
“There could be medications taken in the community
[setting] that the hospital was not aware of, so we always compare outpatient information with what the hospital has and reconcile that,” Feeley explains. “We’ve found that patients would restart home medications, in addition to the new medications they had been prescribed in the hospital, due to misunderstandings.”For example, patients who are admitted to the hospital for pneumonia might receive new antibiotics to take home. But patients could begin using the antibiotics they had at home, in addition to the new ones. This poses a safety risk and could increase the spread of antibiotic-resistant bacteria.
“That’s one example of the duplicate therapies we’d find when they got home,” Feeley says.
Patients deal with a lot while in the hospital, so it is important to contact them after discharge to bridge that gap and obtain information after they are rested and better able to explain which medications they are using.
When the team was worried about a patient’s well-being at home, or when they needed to see the patient’s medications, they could ask a hospital nurse practitioner for a home visit. Or, they could contact the patient’s home care providers to interface with nurses to ensure an additional level of care that included seeing the patient’s home medication, Feeley says.
Pharmacists providing education and coping gives transitions an extra level of care that helps reduce readmissions, says Michael Sanchez, PharmD, BCCCP, pharmacy residency coordinator at Health First Holmes Regional Medical Center. There were no readmissions for COPD in the study group, but patients with congestive heart failure (CHF) experienced challenges, he says. (Read the cover story in this issue for more information.)
Pharmacists can educate patients on CHF symptoms and teach patients and families when to seek emergency or urgent care as well as focus on medication compliance. But CHF still is a challenging disease state.
Bringing pharmacists on the care transitions team is not cheap, but there are ways to make it more efficient. For instance, a health system can use pharmacy residents to contact patients and provide medication reconciliation and follow-up calls.
“Pharmacy residents can help develop the service line and take it further with virtual face-to-face visits,” Sanchez says. “Thanks to COVID and the code modifier [for virtual visits] that’s allowed right now, we can bill for it.”
Training is minimal for pharmacy residents because they have learned about medication reconciliation and know how to talk with patients about their medication therapy, Parodi says. To prepare residents for TOC, the team developed folders for each disease state, including handouts on inhalers and information on discussing signs and symptoms with patients.
“We all get trained for this,” Feeley says. “We created the folders not just to remind ourselves of details, but also to standardize the process because it’s important in any health system to have the same level of care for all patients.”
Working on the TOC project was exciting, particularly for a new pharmacist.
“You were able to see the difference that pharmacists can make on post-discharge and just how impactful the pharmacy profession is,” Parodi explains. “We are the bridge between outpatient and inpatient. We have so many resources, and we’re like the glue — able to create a cohesive way for patients to get all the resources they need and to make sure their readmissions decrease.”
REFERENCE
- Parodi M, Feeley B, Sanchez M. Impact of a pharmacist-driven transitions of care clinic for a multisite integrated delivery network. Am J Health Syst Pharm 2022 Jan 27;zxac029. doi: 10.1093/ajhp/zxac029. [Online ahead of print].
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