A new spin on transitions of care: Pharmacists bridging the gap between inpatient and outpatient settings

Abstract

Introduction: Benefits of pharmacist involvement during transitions of care (TOC) are well validated in the literature, but this role remains highly variable and institution specific. The purpose of this study is to describe the impact on acute health care utilization and overall patient outcomes when a pharmacist is added to a unique TOC team that encompasses both ambulatory and acute care settings. Methods: This study is a retrospective review of an established TOC service that recently added a pharmacist. As part of this service, patients meeting prespecified criteria received pharmacist intervention during inpatient rounds and discharge follow-up visit(s). The primary outcome was the change in number of acute health care encounters (emergency department [ED] visits and/or hospital readmissions). Secondary outcomes included type, frequency, and duration of patients' health care encounters, reason(s) for readmissions/ED visits, clinical pharmacist interventions, and changes in disease state-specific outcomes. Patients served as their own control and results were compared between the 6 months prior to and after initial pharmacist intervention. Results: In total, 44 patients were included. In the 6 months following initial pharmacist intervention, total number of acute health care encounters decreased by 39.5% (P < .001). Among patients readmitted or seen in the ED after initial pharmacist intervention, 28.3% occurred within 30 days of hospital discharge. Acute health care utilization was considered preventable in seven (29.2%) hospital readmissions and three (13.6%) ED visits. Average time between admissions increased by 6.6 days (P = .020). Provider-pharmacist discharge co-visits were completed for 75% of patients and a total of 182 pharmacist interventions were performed. Median time to first discharge follow-up visit was six days (interquartile range, 4-8). Conclusion: Incorporating a pharmacist into an established TOC team, working across both the inpatient and outpatient settings, resulted in a significant decrease in number of acute health care encounters per patient and increased time out of the hospital.

Effect of extended pharmacist involvement in discharge transitions of care on hospital readmission rates: Prospective, randomized, parallel arm design trial

“…This was determined by evaluating previous literature who required a similar number of patients to yield a statistically significant reduction in readmission rates. [1][2][3][4][5][6] The primary outcome was analyzed using chi-squared analysis and secondary outcomes used descriptive statistics. This protocol was approved by the investigation review board (IRB) who waived informed consent.…”

“…A sample size of 148 patients per group was required in order to obtain a power of 80% with an alpha of 0.05 in order to see a 20% reduction in composite ED visits and inpatient readmissions. This was determined by evaluating previous literature who required a similar number of patients to yield a statistically significant reduction in readmission rates 1–6 . The primary outcome was analyzed using chi‐squared analysis and secondary outcomes used descriptive statistics.…”

“…Pharmacist involvement in transitions of care improves patient outcomes and reduces readmission rates. Pharmacists have demonstrated an impact by providing face‐to‐face education to patients on new medication therapies, identifying adverse drug reactions (ADRs), and ensuring medication therapy is appropriate for each medical condition 1–6 . The Centers of Medicare and Medicaid (CMS) use 30 day readmission rates to determine hospital reimbursement rates and can penalize up to a 3% reduction in payment; therefore, pharmacists can increase CMS reimbursement rates by decreasing 30 day readmission rates 1 …”

“…Pharmacists have demonstrated an impact by providing face-to-face education to patients on new medication therapies, identifying adverse drug reactions (ADRs), and ensuring medication therapy is appropriate for each medical condition. [1][2][3][4][5][6] The Centers of Medicare and Medicaid (CMS) use 30 day readmission rates to determine hospital reimbursement rates and can penalize up to a 3% reduction in payment; therefore, pharmacists can increase CMS reimbursement rates by decreasing 30 day readmission rates. 1 The authors of a prospective, randomized, single-period longitudinal study examined the effect of patients receiving the hospital's standard of care compared to pharmacist involvement at discharge.…”

Role of the Pharmacist in Managing Treatment-Resistant Depression: A Focus on Ketamine

“…A pharmacist is an integral part of a treatment team, and an invaluable asset in facilitating logistics and providing drug information to both patients and physicians [ 45 ]. As pharmacists’ scope-of-practice expands, current and ongoing research has illustrated their roles in leading initiatives and establishing programs that aim to bridge the pharmacotherapy gaps in healthcare services [ 46 , 47 , 48 ]. To overcome barriers to providing novel and effective treatments in treatment-resistant depression, effective pharmacy-led leadership and governance is imperative.…”