Optimizing care transitions: the role of the community pharmacist

Abstract

Transitions of care (TOC) refer to the movement of patients across institutions, among providers, between different levels of care, and to and from home. Medication errors that occur during TOC have the potential to result in medical complications that are serious for the patient and costly to the health care system. Positive outcomes have been demonstrated when pharmacists are involved in providing TOC services, including reducing preventable adverse drug reactions, medication-related problems, and rehospitalizations, as well as improving the discharge process. This review explores TOC models involving community pharmacy practice, the current impact of pharmacist interventions in TOC, and patient satisfaction with TOC services provided by community pharmacists. Common barriers and potential solutions to TOC services provided in the community pharmacy, such as patient identification, information gathering, standardization of services, administrative support, reimbursement, and time restraints, are also discussed.

Community Pharmacist Preferences in Transition of Care Communications

“…Survey results indicated community pharmacists have information that could be provided to the hospital or clinic, which may represent underutilized patient information. 11,12 This information included patient allergies, insurance, and medication nonadherence.…”

“…Community pharmacists are uniquely positioned to reduce medication-related problems and 30-day hospital readmissions through their knowledge of patient history, their personal rapport with patients, and the longitudinal nature of patient interactions. 11,12 Therefore, it is critical that there is effective communication among health-care providers in different care settings. 13 Patients visit their PCP an average of 4 times per year and have 9 outpatient visits per year with specialists; however, patients present to their community pharmacist 35 times per year, providing multiple opportunities to positively impact a patient’s care related to medication-related problems.…”

Implementation of a Cardiac Transitions of Care Pilot Program: A Prospective Study of Inpatient and Outpatient Clinical Pharmacy Services for Patients With Heart Failure Exacerbation or Acute Myocardial Infarction

“…The barriers of patient adherence in following up and ability to attend MTM appointments are limitations in the success of transitions of care programs and apply to this study as well. [21][22][23][24] Patients discharged after treatment for HF exacerbation or post-AMI may face logistical barriers in receiving optimal outpatient care, such as lack of transportation. To overcome this obstacle, the transitions of care program contracted with a local taxi service in the geographical region to provide free transportation to the MTM appointments for patients who expressed interest in the MTM service but faced possible difficulty in having a way to get to their appointment.…”

A 15 Year Ecological Comparison for the Market Dynamics of Minnesota Community Pharmacies from 2002 to 2017

“…Since the publication of this research, the role, and importance of community pharmacies has changed and grown in terms of providing public health (e.g., immunizations, opioid rescue drugs, drug disposal) and population health services (medication management, health screening, specialty pharmacy) [ 3 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Other changes like the recovery from the economic downturn of 2008, healthcare legislation (e.g., Patient Protection and Affordable Care Act, Health Care and Education Reconciliation Act), the growth of continuity of care models, and the rise of outcome-based reimbursement systems warrant continued investigation of the market dynamics of community pharmacies in Minnesota [ 18 , 19 , 20 ].…”