Pharmacists' Recommendations to Improve Care Transitions

Abstract

Background Increasingly, hospitals are implementing multi-faceted programs to improve medication reconciliation and transitions of care, often involving pharmacists. Objective To help delineate the optimal role of pharmacists in this context, this qualitative study assessed pharmacists’ views on their roles in hospital-based medication reconciliation and discharge counseling. We also provide pharmacists’ recommendations for improving care transitions. Methods Eleven study pharmacists at two hospitals who participated in the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study completed semi-structured one-on-one interviews, which were coded systematically in NVivo. Pharmacists provided their perspectives on admission and discharge medication reconciliation, in-hospital patient counseling, provision of simple medication adherence aids (e.g., pill box, illustrated daily medication schedule), and telephone follow-up. Results Pharmacists considered medication reconciliation, though time-consuming, to be their most important role in improving care transitions, particularly through detection of errors in the admission medication history that required correction. They also identified patients with poor understanding of their medications, who required additional counseling. Providing adherence aids was felt to be highly valuable for patients with low health literacy, though less useful for patients with adequate health literacy. Pharmacists noted that having trained administrative staff conduct the initial post-discharge follow-up call to screen for issues and triage which patients needed pharmacist follow-up was helpful and an efficient use of resources. Pharmacists’ recommendations for improving care transitions included clear communication among team members, protected time for discharge counseling, patient and family engagement in discharge counseling, and provision of patient education materials. Conclusion Pharmacists are well-positioned to participate in hospital-based medication reconciliation, identify patients with poor medication understanding or adherence, and provide tailored patient counseling to improve transitions of care. Additional studies are needed to confirm these findings in other settings, and to determine the efficacy and cost-effectiveness of different models of pharmacist involvement.

Hospital pharmacists' perceptions of medication counseling: A focus group study

“…Lack of time is frequently cited in the literature as a major barrier to pharmacists conducting medication counselling to hospitalised patients. 16,17,68 One pharmacist explained how time pressures have redefined the concept of discharge medication counselling.…”

“…This difficulty has also been cited in the literature. 16 Pharmacists often felt pulled between a desire to meet the needs of the patient and pressures from other workload demands.…”

“…12 However, little has been published about hospital pharmacists' perceptions about their role in this process and how they believe their practice impacts patients. [13][14][15][16][17] The authors were interested in exploring how hospital pharmacists view their professional role and their individual goals in medication counselling as well as the factors that enable and prevent them from meeting these goals.…”

“…12 However, little has been published about hospital pharmacists' perceptions about their role in this process and how they believe their practice impacts patients. [13][14][15][16][17] The authors were interested in exploring how hospital pharmacists view their professional role and their individual goals in medication counselling as well as the factors that enable and prevent them from meeting these goals.Learning more about how hospital pharmacists perceive their roles and goals in interacting with patients at discharge will provide a better understanding of the current practice followed by pharmacists working in Australian hospitals. This may also help identify gaps in professional practice on which to focus pharmacist education and training as well as some potential areas for expanded professional scope.…”

Pharmacists’ Role in the Care of Patients with Heart Failure: Review and Future Evolution

“…In a follow-up substudy evaluating perspectivces of 11 pharmacists (from the PILL-CVD study) on the value of the intervention, 7 the pharmacists viewed medication reconciliation as the greatest and most important portion of the intervention in improving patient care transitions. The pharmacists also identified groups of patients who may be in greater need of medication reconciliation, particularly patients on multiple medications.…”