Reductions in 30-day readmission, mortality, and costs with inpatient–to–community pharmacist follow-up

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Objective Community pharmacists are often the first healthcare professional encountered following discharge from a hospital, but what extent of services provided is not fully described across a variety of community pharmacy settings. Our objective was to capture and report recommendations made by community pharmacists during a transitions of care interventional study and to determine if visit‐related factors affected the risk of readmission. Methods The content of pharmacists' notes were analyzed from encounters during a transitions of care interventional study for patients discharged from a hospital with five high‐risk conditions (heart failure, acute myocardial infarction, diabetes, pneumonia, or chronic obstructive pulmonary disease), where the primary purpose of the intervention was to enhance inpatient and community pharmacist communication to improve patient care. Summary statistics were utilized to describe the content of pharmacist notes and actions, and a Cox proportional hazards model was used to test for the impact of several patient or visit‐related characteristics on the risk of 90‐day readmissions. Results As part of an interventional study, patients spent an average of 9 minutes (standard deviation [SD] 6.9) with pharmacists during each visit and had three visits on average within 90‐day of discharge. Responses to checklist questions were documented on 99% of notes, and pharmacists provided recommendations 58% of the time. Recommendations varied by condition with the most frequent being adherence (10%), vaccinations (8%), and disease monitoring (7%). In multivariate models, readmission was higher among patients with highest comorbidity (hazard ratio [HR] = 10.18, 95% confidence interval [CI], 3.53‐29.36), two or more medications added at discharge (HR = 3.83, 95% CI, 1.49‐9.82), or vaccine gaps (HR = 3.51, 95% CI, 1.09‐11.33). Conclusions In a transitions of care service, community pharmacists actively engaged patients and caregivers at regular intervals, providing largely patient‐oriented recommendations during relatively short consultation encounters. Patient and visit‐related items associated with higher readmission risk such as higher comorbidity, medication additions, and incomplete vaccinations signal opportunity for community pharmacist‐led interventions to improve care of patients in the postdischarge period.

Section: Community Pharmacists' Interventions During Transitions Of Carementioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Analysis of community pharmacist recommendations from a transitions of care study

Lussier

Graham

Tusing

et al. 2019

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Building a transformative partnership between health‐system and community‐based pharmacies

Vest

Clifton²,

Cochran

et al. 2020

Purpose Health‐system pharmacists and community‐based pharmacists have long held professional relationships. However, the success of each group is often not interdependent and aligned. In 2018, the American College of Clinical Pharmacy (ACCP), CPESN USA, and the National Community Pharmacists Association (NCPA) Innovation Center led a meeting to build patient‐centered pharmacist teams to achieve medication optimization across care settings. Seven community pharmacists and health‐system/clinic‐based pharmacist teams participated in this meeting and left with the intentional commitment to build sustainable partnerships. This report describes the establishment of this partnership, and the subsequent application of Guiding Statements for these collaborations. This report also describes both the successes realized and the lessons learned, and to serve as practical recommendations for institutions interested in pursuing similar partnerships. Results Initial learnings from these partnerships have provided a proof of concept that an intentional approach to the relationship between a health‐system/clinic‐based pharmacist and community‐based pharmacist can lead to improvements in patient care as well as a professional collaboration. We experienced improved communication and closed‐loop care, improved professional relationships across care settings, and enhanced clinical services. However, these partnerships were not without challenges. For instance, lack of interoperability and limited electronic health record access made certain outcomes difficult to track. Conclusion The purposeful establishment of partnerships between health‐system/clinic‐based pharmacists and community‐based pharmacists, built upon the needs of both entities, allowed institutions to develop an aligned commitment to care for shared patients. Over the initial years of these partnerships, many successes were realized and lessons were learned. Both the successes and the challenges can serve as beneficial resources for institutions interested in developing similar partnerships.

Quality measures of clinical pharmacy services during transitions of care

King

Burkhardt

Rafferty

et al. 2021

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.