Losing sleep over transitions of care

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Insomnia

Continuity of care. Transitional care pharmacist. Readmissions penalty. These are common catchphrases and buzzwords used in discussing potential new roles for pharmacists. Keeping up to date with the latest issues and trying to influence health care in a positive way could lead to sleepless nights for many pharmacists.

Pharmacists in all types of practice realize that continuity of care often does not happen for our patients. There are three main vulnerable points while a patient is in the hospital—admission, intrahospital transfer, and discharge. Due to fragmentation of the health care system, problems often arise, especially with medications.

Pharmacists know that patients need help with medication management. In hospital settings, we see patients who are admitted or readmitted because they have not taken their medications correctly and their disease state is not appropriately controlled. Studies have shown that approximately 2 million hospital readmissions each year can be traced to nonadherence. In addition, 12% to 17% of patients experience an adverse drug event after discharge from the hospital.

CMS now penalizes hospitals and health systems for all-cause 30-day readmissions for heart failure, acute myocardial infarction, and pneumonia through decreased reimbursements. All of these issues are evidence of unsatisfactory patient care. Pharmacists can take the lead to help reduce readmission rates and, ultimately, improve patient care. Insomnia does not come from leading this charge, but rather from figuring out how to implement innovative ideas.

  • Innovative practice ideas to reduce readmissions include the following:
  • Medication reconciliation pharmacists at admission, discharge, or both
  • Medication therapy management (MTM) services provided by a hospital or health-system pharmacist or in conjunction with a community pharmacist
  • Transitional care pharmacists who help to manage the move from the hospital to the outpatient setting
  • Chronic care programs managed by pharmacists
  • Pharmacists as health coaches

In each of a patient’s transitions—from home to the hospital and back to home—there are multiple opportunities for pharmacists to improve continuity of care. At admission, the pharmacist can help get it right from the beginning by taking medication histories or identifying medication-related factors that may have led the patient to the hospital. While patients are in the hospital, the pharmacist can make their stay better through education, simplified medication regimens, or prevention of adverse reactions. At discharge, the pharmacist can make it right at the end by facilitating the inpatient to outpatient transition. Last, once patients go home, the pharmacist can help to keep it right through MTM services, chronic care programs, and more.

It is exciting to know that pharmacists are finding opportunities to provide high-quality patient care and show the value of the pharmacist as an integral part of the health care team.

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