Improving Care Transitions: Current Practice and Future Opportunities for Pharmacists

Abstract

During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to issues regarding care transitions and that students have several opportunities to practice the skills needed for effective care transitions. Moreover, reimbursement mechanisms that permit greater pharmacist involvement in providing medication assistance to patients going through care transitions should be explored. Although health information technology offers the potential for safer care transitions, pharmacists' use of information technology must be integrated into the national initiatives for pharmacists to be effectively involved in care transitions. This paper concludes with a discussion about the importance of recognizing and addressing health literacy issues to promote patient empowerment during and after care transitions.

Incorporating Standardized Colleague Simulations in a Clinical Assessment Course and Evaluating the Impact on Interprofessional Communication

“…However, limited information is reported in the pharmacy literature. 18,19,26 Foley and colleagues conducted a small-scale pilot program that trained lay people to portray standardized physicians. Twenty-eight registered professional nurses comprised the intervention group, each of whom engaged in two 15-minute videotaped case scenarios with the standardized physician.…”

“…26 Standardized colleague simulations is one approach to help prepare health professions students for interprofessional interaction and patient-care activities upon graduation. However, limited information is reported in the pharmacy literature.…”

Evaluation of the Impact of Comprehensive Medication Management Services Delivered Posthospitalization on Readmissions and Emergency Department Visits

“…These models are programs highly integrated into health systems with multiple health care providers involved. 18 The comprehensive medication management services provided in the intervention group of this study were done so in collaboration with the interprofessional health care team. The recent literature shows that a team-based approach is required in order to impact hospital readmissions.…”

“…[11][12][13][14][15]18 This may be due to the variability in the types of pharmacist intervention provided, the cultural climate of the health system being studied, or many other factors. One possible reason for this is that the pharmacist plays an important role, but other team members, such as care coordinators and nurse educators, also need to be added to the patient's care team to have a more significant impact in reducing hospital readmissions.…”

“…Some of the largest decreases in health system utilization in the postdischarge period described in the literature are from interventions involving an interprofessional team with care coordination and other health care providers, including pharmacists. 12,18 In this study, pharmacists providing the care were integral members of the primary care team, with well-developed collaborative relationships with the providers. It is believed that this interprofessional approach likely contributed to the positive impact on improvement in mortality.…”