Integrating a health information exchange into a community pharmacy transitions of care service

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: Discussionmentioning

confidence: 98%

Analysis of community pharmacist recommendations from a transitions of care study

Lussier

Graham

Tusing

et al. 2019

“…Most successful community pharmacy TOC interventions occur through a comprehensive medication review (CMR) intervention by telephone to improve outcomes (Table ) . Telephone interventions are advantageous because patients should not travel if not feeling well, and a telephone call can easily be incorporated into the pharmacist's workflow.…”

Section: Best Practicesmentioning

confidence: 99%

“…Moreover, use of HIEs by community pharmacies has expanded in recent years, with some HIE systems integrating their data into pharmacy dispensing software . In one study that used a state HIE to access patients’ discharge documentation, 85% of participants had an electronic medical record in the exchange . However, the quality of the information was highly variable, with only 50% of the patients having a documented reason for admission and only 12.5% having a discharge medication list available.…”

Section: Best Practicesmentioning

confidence: 99%

“…Having access to patient health information data and a direct line of communication with the patient's primary care team is ideal for community pharmacies. This is important because time spent by community pharmacists or support personnel in delivering medications, tracking down medication lists, or calling primary care providers for the medication information needed to complete medication reconciliations and following up on medication‐related problems accrues staffing costs …”

Section: Best Practicesmentioning

confidence: 99%

“…Community pharmacy interventions can generate revenue or offset costs through MTM billing, TCM billing if integrated into clinic‐based medical records, medication delivery, and unique partnerships with primary care clinics . Feldman et al described a collaborative model in which a hospital paid 11 community pharmacies $40 per discharge follow‐up telephone call, which contributed to reduced readmissions .…”

Section: Best Practicesmentioning

confidence: 99%

See 2 more Smart Citations

Role of clinical pharmacists and pharmacy support personnel in transitions of care

Stranges

Jackevicius

Anderson

et al. 2020

Patients moving between health care settings or providers are at increased risk of complications, including unplanned hospital readmissions and medication errors. Several actions must occur in concert with members of the health care team and across settings to ensure coordinated and continuous care for patients undergoing these transitions of care (TOC). Clinical pharmacists support patients during care transitions by providing interventions and services designed to improve medication outcomes. Clinical pharmacists and team members who support clinical pharmacist activities (eg, pharmacy students, technicians, and residents) are located throughout the care continuum, from acute care to care in the community, with each contributing to improved TOC outcomes. This article provides information on evidence of high‐impact clinical pharmacist TOC practices to serve as a practical guide for practitioners interested in starting or improving TOC activities. This article also addresses current and emerging best practices and offers suggestions for improving clinical pharmacist involvement in care transition activities.

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.