“I can’t afford that medication, but I need something to help me.” A patient, “John,” had been recently seen for Irritable Bowel Syndrome with constipation in the emergency department, where he received a new prescription. When he went to his pharmacy, he was told that his insurance did not cover his new medication. It was several days before he came in to see his primary care physician. When investigating the situation, it was learned that he did not know the name of the medication nor did he have discharge instructions with him. The clinic had also not received his medical records from the hospital.
How would you go about resolving John’s situation? How would you prevent similar situations from happening?
John’s example demonstrates how poor transitions of care can negatively affect a patient. Various national health and safety organizations have focused on improving care transitions because poor transitions put patients at risk for worse outcomes. But what does it take to have a successful transition of care? Addressing barriers and implementing delivery models are key steps in paving the way to highly effective transitions of care.
Barriers to implementation
Although health care systems are increasingly incorporating transitions of care practices, barriers remain that interfere with program creation and implementation. The joint report ASHP–APhA Medication Management in Care Transitions Best Practices outlines several common barriers health institutions and pharmacists may face during program development. Common barriers identified by the report include funding, staffing, health information technology, and lack of communication.
It can be difficult to obtain the necessary funding and resources for implementing transitions of care services as budgets are limited both within the pharmacy department and across the institution. Consequently, it takes the support of the entire health care institution to provide the initial funding in order to reap the long-term cost savings. Additional staff and hours are required with the addition of a new service, and so pharmacy departments often must become creative in providing staff to support transitions of care services.
Lack of medical record access and interoperable documentation systems make it difficult to have adequate patient medication histories and may require multiple documentation methods, which ultimately have an impact on quality and efficiency. Interruptions in communication among pharmacists, providers, partners, patients, and leadership can compromise the quality of care. These barriers, and others that arise, need to be addressed to ensure the continuing progression and success of a new transitions of care service.
Program models
Pharmacists have been instrumental in program design so that medication management is optimized during the transition process. As noted in the joint report, pharmacists at the Hennepin County Medical Center (Minneapolis, MN), for example, used a modified Project RED transitions of care model that showed a reduction in 30-day readmission rates from 23% to 8% for eligible patients that participated in all steps of the transitions of care process. In this Project RED model, pharmacists
performed medication reconciliation and provided patient education and medication therapy management
services with interventions occurring both upon discharge and post-discharge.
Also, the Einstein Healthcare Network implemented the Medication REACH program model to lower
readmission rates for uninsured patients from 21.4% to 10.6%. In the Medication REACH model, pharmacists
perform medication reconciliation (R), provide patient education (E), and
resolve medication access (A) through comprehensive counseling (C) to
ultimately result in healthy (H) patients after discharge.
Although transitions of care models may vary, results consistently show that patients and health institutions benefit greatly when pharmacists are involved in the care transitions process.
How to learn more
If you are interested in this topic, sign up today for the APhA Transitions of Care Special Interest Group (SIG) on APhA Engage (http://engage.
pharmacist.com/home) to learn more about best practices in transitions of care, how to overcome barriers to program implementation, and more about different models pharmacists are implementing in a variety of practice
settings. In the Transitions of Care SIG, you can also hear more from experts around the country about developments in this emerging area of pharmacy practice. Also, be sure to check out our first episode of Off Script, an APhA–ASP Policy Standing Committee podcast series, to learn more about pharmacist and student pharmacist involvement in transitions of care. You can find all of the Off Script episodes on the APhA–ASP YouTube page (https://www.youtube.com/user/APhAASP).
Have you had experience in transitions of care? If so, please share your thoughts and experiences with your
fellow student pharmacists today!
The 2017–18 APhA–ASP Policy Standing Committee consists of Jason Gaines (NEC liaison), Mary Bradley (Chair), Daniel Galipeau, Adrienne Simmons, and Andrew Stone.