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“Pitching” pharmacists as improvers of transition-of-care outcomes
DEPARTMENTS Journal of the American Pharmacists Association 56 (2016) 348
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
SCIENCE UPDATES
“Pitching” pharmacists as improvers of transition-of-care outcomes Patrick G. Clay
A notable trend in the medical literature is the focus on approaches to achieve improvements in transitionsof-care. Complementing the increase in publications seeking this are manuscripts describing the role pharmacistsd inpatient and outpatientdin meeting that need. It is notable that pharmacists have demonstrated clear benefit in numerous aspects of transition of care, including at the point of admission,1 preparing the patient for discharge,2 and moving to and from transition-ofcare units.3 Human immunodeficiency virus (HIV) patients represent complicated scenarios to hospitals both from a medication perspective and because of the critical balance achieved with virologic suppression, tolerability, and remaining antiretroviral agents remaining for the patient to use. Maintaining the regimen carefully constructed in the outpatient setting is of utmost importance when HIV patients are admitted to the hospital. A group of researchers in Oklahoma examined how having a pharmacist review medications at admission affected medication errors. The analyses revealed statistically significant improvements (decreases) in medication error rates categorized as incorrect dose (P <0.001), incorrect frequency (P ¼ 0.002), and drug interactions (P <0.001) in 330 admissions of 184 patients. Collectively, the pharmacist engagement resulted in a 73.9% reduction of errors (P <0.001) that was independent from antiretroviral regimen, renal function, or any patient demographic. This initiative clearly
demonstrates the benefit of having a pharmacist involved at the admission stage of transitions-of-care. A primary focus for many health systems is the component of transitions-ofcare involving returning the patient back to the community. A prospective randomized trial at an urban medical center examined if pharmacists, providing faceto-face discharge counseling and then following up via telephone 3 times in 30 days made a difference. Researchers found that indeed they did. In the 137 patients receiving the pharmacist intervention, fewer patients went back to the emergency department to receive care (4.4% vs. 14.8%; P ¼ 0.005), and when they did go to the emergency department or back to the hospital, a longer period of time had occurred (7.9 days vs. 13.2 days; P ¼ 0.03). There was no statistical difference in the readmission rates although they were 20.4% versus 23.9%. Finally, patients moving through transitions-of-care units are likely to benefit from receiving more than the federally mandated minimal monthly drug regimen review. A recently published report describes a collaborative effort between an academic pharmacist and health system to address both time
periods of admission and discharge from these “step-down” units. Although the paper unfortunately does not provide quantitative outcome measures, the authors’ description of the manner in which the service was constructed could be used as a blueprint for others to follow. With the use of these and many other published reports, the recommendation to those seeking ways to improve their health systems’ transitions-of-care programs is: Spring training is over. Add a pharmacist to your roster. Now, let’s play ball.
References 1. Liedtke MD, Tomlin CR, Skrepnek GH, Farmer KC, Johnson PN, Rathbun RC. HIV pharmacist’s impact on inpatient antiretroviral errors. HIV Med. 2016:1e7. 2. Phatak A, Prusi R, Ward B, Hansen LO, Williams MV, Vetter E, et al. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education and postdischarge call-backs (IPITCH study). J Hosp Med. 2016;11:39e44. 3. Reidt S, Sibicky S, Yarabinec A. Transitional care units: expanding the role of pharmacists providing patient care. Consult Pharm. 2016;31:44e48. Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, APhA Science Officer and Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal's readership. APhA members who have published research are encouraged to forward the PubMed citation, or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, at [email protected].
http://dx.doi.org/10.1016/j.japh.2016.04.558 1544-3191/© 2016 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
SCIENCE UPDATES
“Pitching” pharmacists as improvers of transition-of-care outcomes Patrick G. Clay
A notable trend in the medical literature is the focus on approaches to achieve improvements in transitionsof-care. Complementing the increase in publications seeking this are manuscripts describing the role pharmacistsd inpatient and outpatientdin meeting that need. It is notable that pharmacists have demonstrated clear benefit in numerous aspects of transition of care, including at the point of admission,1 preparing the patient for discharge,2 and moving to and from transition-ofcare units.3 Human immunodeficiency virus (HIV) patients represent complicated scenarios to hospitals both from a medication perspective and because of the critical balance achieved with virologic suppression, tolerability, and remaining antiretroviral agents remaining for the patient to use. Maintaining the regimen carefully constructed in the outpatient setting is of utmost importance when HIV patients are admitted to the hospital. A group of researchers in Oklahoma examined how having a pharmacist review medications at admission affected medication errors. The analyses revealed statistically significant improvements (decreases) in medication error rates categorized as incorrect dose (P <0.001), incorrect frequency (P ¼ 0.002), and drug interactions (P <0.001) in 330 admissions of 184 patients. Collectively, the pharmacist engagement resulted in a 73.9% reduction of errors (P <0.001) that was independent from antiretroviral regimen, renal function, or any patient demographic. This initiative clearly
demonstrates the benefit of having a pharmacist involved at the admission stage of transitions-of-care. A primary focus for many health systems is the component of transitions-ofcare involving returning the patient back to the community. A prospective randomized trial at an urban medical center examined if pharmacists, providing faceto-face discharge counseling and then following up via telephone 3 times in 30 days made a difference. Researchers found that indeed they did. In the 137 patients receiving the pharmacist intervention, fewer patients went back to the emergency department to receive care (4.4% vs. 14.8%; P ¼ 0.005), and when they did go to the emergency department or back to the hospital, a longer period of time had occurred (7.9 days vs. 13.2 days; P ¼ 0.03). There was no statistical difference in the readmission rates although they were 20.4% versus 23.9%. Finally, patients moving through transitions-of-care units are likely to benefit from receiving more than the federally mandated minimal monthly drug regimen review. A recently published report describes a collaborative effort between an academic pharmacist and health system to address both time
periods of admission and discharge from these “step-down” units. Although the paper unfortunately does not provide quantitative outcome measures, the authors’ description of the manner in which the service was constructed could be used as a blueprint for others to follow. With the use of these and many other published reports, the recommendation to those seeking ways to improve their health systems’ transitions-of-care programs is: Spring training is over. Add a pharmacist to your roster. Now, let’s play ball.
References 1. Liedtke MD, Tomlin CR, Skrepnek GH, Farmer KC, Johnson PN, Rathbun RC. HIV pharmacist’s impact on inpatient antiretroviral errors. HIV Med. 2016:1e7. 2. Phatak A, Prusi R, Ward B, Hansen LO, Williams MV, Vetter E, et al. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education and postdischarge call-backs (IPITCH study). J Hosp Med. 2016;11:39e44. 3. Reidt S, Sibicky S, Yarabinec A. Transitional care units: expanding the role of pharmacists providing patient care. Consult Pharm. 2016;31:44e48. Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, APhA Science Officer and Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal's readership. APhA members who have published research are encouraged to forward the PubMed citation, or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, at [email protected].
http://dx.doi.org/10.1016/j.japh.2016.04.558 1544-3191/© 2016 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.