Process Indicators of Quality Clinical Pharmacy Services During Transitions of Care

Abstract

The American College of Clinical Pharmacy charged the Public and Professional Relations Committee to develop a short white paper describing quality measures of clinical pharmacists' patient care services in transitional care settings. Transitional care describes patient movement from one health care setting or service to another. Care transitions are associated with an increased risk of adverse events for patients. Pharmacists play an important role in ensuring that medication errors and adverse events are minimized during these transitions, largely through the reconciliation of medications and assurance of continuity of care. Quality measures are often divided into three domains: structure, process, and outcome. Given the typical nature of the pharmacist's role, process indicators are best suited to evaluate quality clinical pharmacist services. However, process indicators relevant to pharmacists' activities are not yet fully described in the literature. The committee searched available literature describing quality measures that are directly influenced by the pharmacist during care transitions. This white paper describes these process indicators as quality measures of clinical pharmacists' services, identifies the transitional settings and activities to which they are most applicable, and provides the published sources from which indicators were derived. For process indicators that could not be found in published sources, we propose relevant measures that can be adapted for use in a given setting. As pharmacists become more involved in diverse and emerging patient care areas such as transitional care, it will be critical that they use these types of measures to document the quality of new services and reinforce the need for pharmacist participation during transitions of care.

Identifying Community Pharmacists' Readiness to Participate in Transitions of Care

“…Pharmacists in the community setting have the ability to resolve medication discrepancies, improve patient understanding of medications, and address adverse effects. 1,2,5 These factors can all affect a patient's adherence to medications and may be improved by pharmacist interventions in the post-discharge period.…”

“…Of those individuals readmitted, 76% were described as being potentially preventable, resulting in an additional $12 billion healthcare dollars spent. [2][3] In 2011, the Affordable Care Act established the Hospital Readmissions Reduction Program to reduce payments for hospitals with excess readmissions. This program focuses specifically on 30 day readmissions for acute myocardial infarction, heart failure, and pneumonia.…”

“…These undesirable outcomes often contribute to hospital readmission and could be prevented with improved care coordination. 1,2,5 Community pharmacists are in a unique position to widely impact patient health outcomes and decrease hospital readmission rates by identifying and resolving drug related problems. Currently, the majority of community pharmacists are not reimbursed for transitions of care services and there is no research regarding their readiness to do so.…”

Care Transitions in Elderly Heart Failure Patients: Current Practices and the Pharmacist's Role

“…The transition from home to hospital is a high source of medication errors, which emphasizes the importance of medication reconciliation at hospital admission. 24 Medication reconciliation is also one of the primary interventions made at discharge to identify changes in regimens and reduce errors; however, evidence shows that room for improvement exists in this area as medication errors are still prevalent, and patients do not always understand their regimens. A prospective study of 377 elderly patients discharged with hF, ACS, or pneumonia found that more than 80% of patients experienced a prescribing error at discharge or did not comprehend at least one of their medication changes at discharge.…”

Reduction of 30-Day Hospital Readmissions after Patient-centric Telephonic Medication Therapy Management Services

“…2 The National Transitions of Care Coalition (NTOCC) also endorsed the use of pharmacists in the care plan, including medication reconciliation, medication management sessions, comprehensive medication counseling, assessment of patient and caregiver understanding, and telephonic follow-up. 3 Finally, the American Society of HealthSystem Pharmacists (ASHP) and American Pharmacists Association (APhA) published a best practices paper that provided profiles for 8 successful programs as part of the Medication Management in Care Transitions (MMTC) project.…”