An electronic tool for health systems to assess and communicate discharge medication access

Abstract

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to describe how the discharge medication cost inquiry (DMCI) consult order and workflow were created and used to communicate transition of care needs and medication access barriers before discharge. Summary Health-system pharmacists collaborated with the information technology department to develop the DMCI consult order and workflow. This institutional review board–approved retrospective case study evaluated use of the DMCI consult order throughout the health system. Outcomes that could not be retrieved electronically were collected for every third patient encounter using manual chart review. The DMCI consult order was used at each hospital in the health system. Physicians placed the most DMCI consult orders; however, pharmacists at the large academic tertiary hospital utilized the DMCI consult order the most. The DMCI consult order was sent most frequently for anticoagulants. Although most medications were covered by insurance, the tool and workflow identified barriers to medication access. Almost 90% of the patients with a DMCI consult order had at least one prescription generated on discharge. Conclusion The DMCI consult order is a novel electronic tool to aid in communicating discharge medication needs. When incorporated into care transition planning, the DMCI consult order and workflow provide a model to ensure patients have access to medications. It can also be used to document and evaluate the role of pharmacy in transitions of care in the health system.

Transitions of care: An untapped opportunity for antimicrobial stewardship

“…Once the discharge antibiotic selection, dose, and duration were agreed upon, the pharmacist entered the discharge order in the EHR per protocol, with an additional note on the appropriate end date, to be signed by the provider. The pharmacist could also send an electronic discharge medication cost inquiry to the discharge pharmacy queue to review medication coverage and copayments prior to placing the discharge order 32 . A note was then placed in the EHR by the pharmacist as a plan of care document, describing the discharge antimicrobial regimen and end date.…”

“…The pharmacist could also send an electronic discharge medication cost inquiry to the discharge pharmacy queue to review medication coverage and copayments prior to placing the discharge order. 32 A note was then placed in the EHR by the pharmacist as a plan of care document, describing the discharge antimicrobial regimen and end date. Interprofessional communication was primarily pager-based.…”

The Impact of Electronic Health Record Interventions on Patient Access to Post-Hospital Discharge Prescriptions

“…Insurance prior authorizations (PAs) are a particular pain point for patients and providers and make up the most common post-discharge inquiry about prescriptions. 4 While intended to control healthcare cost without negatively impacting health outcomes, in practice, PAs introduce administrative burden to healthcare staff and lead to decreased medication usage. [5][6][7] Studies have shown that each PA takes a median of 30 to 46 minutes of providers' time to complete and 22 days to process.…”

“…With the increasing use of EHRs, interventions embedded within the EHR have shown potential to improve the discharge process on a systemic level. 4,22,23 At an 8-hospital system, a transition-in-care (TIC) team composed of pharmacists and nurses followed up with patients after discharge to identify and help resolve any postdischarge barriers. The recurrent issues identified by the TIC team from patients' responses prompted the creation of system-wide EHR interventions to address the most common barriers.…”

“…With the increasing use of EHRs, interventions embedded within the EHR have shown potential to improve the discharge process on a systemic level. 4,22,23…”