Medication Experts Hold Key to Transitions of Care
By Patrick Johnson, PharmD
I have only ever owned one car: a 1996 Acura Integra that I purchased (with my parents’ help) shortly after my 16th birthday. It ran like a dream… until it hit the 150,000 mile mark. For the next year, I was in and out of my local auto repair shop. They would attempt to fix the same issue time and time again with no permanent resolution. Frustrated, I finally got to the bottom of the problem: they had never seen this exact problem and every intervention they tried just didn’t do the trick. It was then that I realized this mechanic fixed lots of types of cars with lots of types of problems, but didn’t specialize in any specific type of vehicle. In other words, they weren’t Acura experts. After locating a mechanic who specialized in Acura vehicles, they were able to accurately diagnosis the problem and fix it. 100,000 miles later, my car is still going strong.
Involving the Medication Experts in Transitions of Care. Just like my Acura’s problems were quickly solved when I involved the right mechanic, with over one-quarter of all hospital readmissions attributed to potentially preventable medication issues, it’s time that our health care system starts involving the medication experts: Pharmacists. Pharmacists are uniquely qualified in medication management. In North Carolina, Clinical Pharmacist Practitioners (CPP) have patient care privileges and prescriptive authority under the supervision of a licensed physician. Pharmacists are truly the medication experts and, with a recent estimate putting the cost of hospital readmissions at over $40 billion annually and a Medicare readmission rate of nearly 20%, it’s long past time to invest in Pharmacists’ expertise.
Preventing Readmission Starts with Admission. More than half of patients have one or more unintended medication discrepancies at hospital admission, which can often persist throughout the hospitalization. Not only is the gathering of an accurate medication history of critical importance, a pharmacist medication review at admission can drastically and positively impact the patient’s hospital stay and beyond. In a 2015 study of older adults, a pharmacist medication review at admission resulted in the identification of one or more potentially inappropriate medications in nearly 20% of patients and at least one drug therapy problem in 86.5% of patients. When these types of issues go unnoticed, hospital costs rise and patient outcomes suffer.
Discharge and Beyond. In the Pharm2Pharm model, hospital pharmacists identify older adult patients at high risk of drug therapy problems, participate as an integral part of the care team through the discharge planning process, and coordinate the patient’s care with a community-based pharmacist that follows the patient for up to one year, including regular in-person visits. Overall, the Pharm2Pharm collaborative approach was associated with a 36% reduction in medication-related hospitalizations and a 2.6:1 return on investment. In the IPITCH study, pharmacist-delivered face-to-face medication reconciliation and counseling, alongside post-discharge phone calls, as compared to usual care provided by other members of the healthcare team resulted in statistically significant decreases in inpatient readmissions and Emergency Department visits. Both studies demonstrate the value of the pharmacist not only at discharge but once the patient returns home.
Often drug therapy problems cannot be fully addressed in the days following discharge and require longitudinal follow-up to ensure adequate resolution. Patient engagement is the number one predictor of medication adherence: engaged patients are 2.57 times more likely to be adherent to their regimen. Due to the estimated $100-$300 billion annual cost of medication non-adherence, ongoing pharmacist involvement on the care team is of critical importance as our healthcare system fully transitions to a value-based payment model.
Emtiro Health knows the value that Pharmacists bring to the care team. We integrate Pharmacists into our care management teams and we work with practices and provider settings to identify appropriate ways to integrate clinical pharmacists to improve patient care and expand access to services.
In the end, I grew tired of taking my car into the shop and of throwing money away with repetitive visits so I got an expert involved that was uniquely qualified to get to the heart of the problem. Our patients are similarly tired of being readmitted to the hospital, often for preventable medication-related issues. As health care costs continue to rise due in large part to non-adherence and misuse of medications, we must invest in the expertise of pharmacists during transitions of care.