Many treatment options are available for patients with insomnia. Behavioral therapies should be initiated as first-line treatment in most patients. For patients who require the addition of pharmacologic therapy, the drugs with the most evidence for benefit include benzodiazepines, benzodiazepine-receptor agonists, melatonin-receptor agonists, and antidepressants. Selection of a specific agent must take into account numerous patient-specific factors.

Background: There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists. Objective: To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs). Methods: A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-toface meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care. Results: Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS. Conclusions: Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

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We conducted a baseline study of warfarin patient education process by (1) assessing a healthcare facility’s current compliance with the education requirements for anticoagulation therapy, (2) assessing how effectively warfarin education was being provided in terms of patient’s knowledge and (3) identifying areas where process improvements were warranted. The facility is an acute care teaching hospital and a Level I Trauma Center with a pharmacist-managed outpatient anticoagulation clinic. We collected data from patients concerning (1) six warfarin knowledge domains (drug-nutrition interactions, drug-drug interactions, monitoring, drug information, dosing and adverse effects), (2) whether or not patients received warfarin education upon discharge and which healthcare professional provided this education (physician, pharmacist, nurse), (3) duration of warfarin therapy, (4) self-rated knowledge of warfarin, and (5) various demographics. Study results indicated the need to implement improvements to the education process to ensure that warfarin education is consistently and routinely provided to all patients prior to being discharged on warfarin with particular attention given to patients sixty years of age and older. Education provided should focus on drug-nutrition and drug-drug interactions, which were found to be areas of highest knowledge deficit. Improvements to the process of providing warfarin education at our hospital may additionally include implementation of a protocol to identify patients requiring education, and a standardized educational program with a pharmacist- managed warfarin discharge counseling service.

Quality-improvement initiatives including staff education, incorporation of REMS requirements into existing policy, development of an electronic resource, and creation of a separate storage section for drugs subject to REMS were implemented at a large academic medical center to help ensure compliance with inpatient-applicable REMS requirements.