This study provides new information from previous studies and represents the largest study with significant and sustained reductions in re-presentations. Integrating a pharmacist into an interdisciplinary team for medication management during TOC in a community health system is beneficial for patients and financially favorable for the institution.

The impact of clinical pharmacy transitions of care (TOC) services on relevant quality measures (QMs) has been a major focus in the recent biomedical literature. The 2020 ACCP Transitions of Care Task Force was charged with updating a 2012 white paper that focused on process indicators of quality clinical pharmacy services during TOC. The Task Force extensively reviewed the recent literature and regulatory measures relevant to TOC services. Given the wide heterogeneity and apparent uncertainty in these measures, the Task Force identified a need to define broader groupings for QMs so that pharmacy TOC services could more be reliably compared across various institutions and practice settings. The Task Force recommends QMs for the processes used to identify, and ultimately resolve, medication discrepancies (QM‐1) and medication therapy problems (MTPs) (QM‐2). Although interventions through various processes can be used to resolve medication discrepancies and MTPs, the findings of these interventions are closely aligned with the major outcomes from these TOC services. Therefore, the Task Force strongly recommends that the successful resolution of medication discrepancies and MTPs be studied for their potential roles as intermediate, or surrogate, QMs (iQM‐1, iQM‐2, respectively) because these are most likely to directly influence or predict quality related to major outcomes from TOC services. In addition, three QMs related to major outcomes are recommended, which are consistent with the triple aim: QM‐3: Health Care Utilization (HCU), QM‐4: Satisfaction and Engagement, and QM‐5: Economics. QM‐3, QM‐4, and QM‐5 span patient‐centered outcomes to institutional, or clinician‐based, outcomes. Specific metrics used for each QM are recommended. In addition to highlighting confounding variables affecting findings in the recent literature, broader contextual considerations that may support TOC services or span multiple practice settings are summarized. Future studies must adopt standard QMs and seek to understand the potential of iQMs to accurately predict success within major patient‐centered and institutional outcomes.

Background Current data shows 30% of patients hospitalized for Chronic Obstructive Pulmonary Disease (COPD) exacerbation are readmitted within 30 days. Medication management during transitions of care (TOC) has shown impact on clinical outcomes, however there is insufficient data to suggest how pharmacy TOC services might benefit this patient population. Objective Evaluate the effects of pharmacy-driven COPD TOC services on hospital re-presentation rates. Methods A single-center retrospective chart review conducted of patients hospitalized for a COPD exacerbation. A comprehensive admission-to-discharge TOC service was provided by early immersion pharmacy students, advanced immersion pharmacy students, and an attending pharmacist in a layered learning model. The primary outcome was 30-day re-presentation rate. Secondary outcomes were 90-day re-presentation rate, volume of interventions made and description of the service. Results From 1/1/2019 to 12/31/2019, there were 2422 patients admitted for COPD exacerbation management and 756 patients received at least one intervention from the COPD TOC service. 30% needed a change to inhaler therapy. The provider accepted 57.8% of the recommended changes, and 36% and 33% of eligible patients received an inhaler technique education and bedside delivery of the new inhaler, respectively. Outcomes in the 30-day re-presentation and 90-day censored re-presentation rates for the intervention and control group were 28.5% vs 25.5% ( P = .12) and 46.7% vs 42.9%, respectively. Conclusion This study did not find a significant change in 30-day re-presentation rate with a pharmacy-driven COPD TOC service. It did find that a significant number of patients admitted with COPD exacerbation may need an inhaler change, and demonstrates the utility of this kind of TOC service for identifying and correcting medication-related problems unique to this disease state. There were opportunities for improvement in percent of patients receiving the full intended intervention.

IntroductionQuality experiential education (EE) programs are the mainstay of hands‐on learning for Doctor of Pharmacy (Pharm.D.) candidates, but challenges remain in the health system setting regarding capacity. Layered‐learning practice models (LLPM) provide the opportunity to both increase student capacity and add benefit to the hospital pharmacy department.ObjectivesThe primary objective of this study was to describe a before and after assessment of a rotation practice model change to benefit departmental goals at a community teaching hospital.MethodsThe Clinical Training Center (CTC) model was implemented in 2016 in tandem with a curricular transformation at the University of North Carolina Eshelman School of Pharmacy. Faculty within the hospital pharmacy department developed a model to accommodate an increased student capacity and created a hands‐on, layered‐learning environment to provide direct patient care to non‐rounding clinical inpatient units and decreased staff‐to‐patient bed volumes.ResultsWith the implementation of the CTC rotation model, student capacity on the health systems and transitions of care rotations increased by 2.4‐fold (from 32 student‐months to 77 student‐months per year). The student‐driven care team provided comparable levels of clinical interventions to decentralized clinical pharmacists and increased direct patient contact by 2.2‐fold. Six decentralized clinical pharmacists experienced a 48% decrease in patient volume due to the CTC model. Capacity concerns within the institution were alleviated without the need for additional pharmacist preceptors. Other benefits of the model included peer‐to‐peer learning between different student levels and successful transition to a predominantly online training platform.DiscussionThe CTC model successfully provided hands‐on patient care opportunities to multiple levels of pharmacy students in an LLPM. This model allowed for similar rates of clinical pharmacy intervention to decentralized pharmacists, decreased clinical pharmacist‐patient volumes, and increased face‐to‐face patient contact by pharmacy personnel.