Amy K. Kennedy

Improving Care Transitions: Current Practice and Future Opportunities for Pharmacists

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.

Integration of collaborative medication therapy management in a safety net patient-centered medical home.

OBJECTIVEnTo describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH).nnnSETTINGnFederally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010.nnnPRACTICE DESCRIPTIONnA CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up.nnnPRACTICE INNOVATIONnCMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals.nnnMAIN OUTCOME MEASURESnNumber of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations.nnnRESULTSnSince October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted.nnnCONCLUSIONnIntegrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

The role of academic pharmacy in tobacco cessation and control.

Despite decades of public health initiatives, tobacco use remains the leading known preventable cause of death in the United States. Clinicians have a proven, positive effect on patients’ ability to quit, and pharmacists are strategically positioned to assist patients with quitting. The American Association of Colleges of Pharmacy recognizes health promotion and disease prevention as a key educational outcome; as such, tobacco cessation education should be a required component of pharmacy curricula to ensure that all pharmacy graduates possess the requisite evidence-based knowledge and skills to intervene with patients who use tobacco. Faculty members teaching tobacco cessation-related content must be knowledgeable and proficient in providing comprehensive cessation counseling, and all preceptors and practicing pharmacists providing direct patient care should screen for tobacco use and provide at least minimal counseling as a routine component of care. Pharmacy organizations should establish policies and resolutions addressing the profession’s role in tobacco cessation and control, and the profession should work together to eliminate tobacco sales in all practice settings where pharmacy services are rendered.

A qualitative analysis of perceptions and barriers to therapeutic lifestyle changes among homeless hypertensive patients

BACKGROUNDnHomeless individuals have higher rates of hypertension when compared to the general population. Therapeutic lifestyle changes (TLCs) have the potential to decrease the morbidity and mortality associated with hypertension, yet TLCs can be difficult for homeless persons to implement because of competing priorities.nnnOBJECTIVESnTo identify: (1) Patients knowledge and perceptions of hypertension and TLCs and (2) Barriers to implementation of TLCs.nnnMETHODSnThis qualitative study was conducted with patients from an urban health care for the homeless center. Patients ≥18 years old with a diagnosis of hypertension were eligible. Three focus groups were conducted at which time saturation was deemed to have been reached. Focus group sessions were audio recorded and transcribed for data analysis. A systematic, inductive analysis was conducted to identify emerging themes.nnnRESULTSnA total of 14 individuals participated in one of the 3 focus groups. Most were female (n=8) and African-American (n=13). Most participants were housed in a shelter (n=8). Others were staying with family or friends (n=3), living on the street (n=2), or had transitioned to housing (n=1). Participants had a mixed understanding of hypertension and how TLCs impacted hypertension. They were most familiar with dietary and smoking recommendations and less familiar with exercise, alcohol, and caffeine TLCs. Participants viewed TLCs as being restrictive, particularly with regard to diet. Family and friends were viewed as helpful in encouraging some lifestyle changes such as healthy eating, but less helpful in having a positive influence on quitting smoking. Participants indicated that they often have difficulty implementing lifestyle changes because of limited meal choices, poor access to exercise equipment, and being uninformed about recommendations.nnnCONCLUSIONSnDespite the benefits of TLCs, homeless individuals experience unique challenges to implementing TLCs. Future research should focus on developing and testing interventions that facilitate TLCs among homeless persons. The findings from this study should assist health care practitioners, including pharmacists, with providing appropriate and effective education.

Outcomes of annual wellness visits provided by pharmacists in an accountable care organization associated with a federally qualified health center

BACKGROUNDnThe clinical and financial outcomes of annual wellness visits (AWVs) conducted by clinical pharmacists working as part of an accountable care organization (ACO) in a federally qualified health center were evaluated.nnnMETHODSnIn this retrospective, single-center, chart review study, patients seen for AWVs at El Rio Health Center between October and December 2013 were eligible for study inclusion. Data collected from patient charts included patient demographics, preventive screenings ordered by clinical pharmacists during the AWV and completed within one month after the visit, other screenings completed by clinical pharmacists during the visit, medication changes by clinical pharmacists, and revenues collected from the AWV and preventive screenings. Descriptive statistics were calculated and variables compared; p values were calculated using single-sample Students t tests.nnnRESULTSnThree hundred patient records were reviewed. Clinical pharmacists completed 1608 interventions, with a mean of 5.4 interventions per patient. A total of 272 referrals were made, 120 (45%) of which were completed within one month of the visit. Of the 183 laboratory tests ordered for diabetes and lipid screening, 152 (83%) were completed within one month of the AWV (p < 0.001). Of the 370 vaccinations offered during the visits, 182 (49%) were administered (p < 0.001). Twenty-four medication and dosage changes were made by clinical pharmacists during AWVs, and the total revenue for the AWVs conducted by pharmacists and services completed during the visits exceeded

Medication reconciliation campaign in a clinic for homeless patients

22,000.nnnCONCLUSIONnRecommendations made by pharmacists during AWVs in an ACO associated with a federally qualified health center had a high acceptance rate and generated substantial revenue.

Medication reconciliation: an important piece of the medication puzzle.

Patients commonly see multiple health care providers, obtain prescribed medications from more than one pharmacy, and transition between inpatient and outpatient settings, all of which can lead to inaccurate medication information and, ultimately, medication errors.[1][1]–[4][2] In fact, it has

Baseline metabolic monitoring of atypical antipsychotics in an inpatient setting

Medication errors continue to cause significant morbidity and mortality. This, in turn, costs the health care system millions of dollars each year in preventable costs. Medication reconciliation, an important piece of medication therapy management (MTM), is vital to reducing medication errors. By verifying, clarifying, and reconciling medications at each point of care, pharmacists can play a vital role in improving health care and lowering costs. This case study describes an MTM session with a 66-year-old Caucasian female who is referred by the nurse practitioner in the clinic for pharmacist services. The patient has a history of portal hypertension, alcoholic liver damage, and chronic obstructive pulmonary disease. After obtaining a detailed history, the pharmacist identified significant medication-related problems including polypharmacy, nonadherence, drug-alcohol interactions, and inappropriate use of medication. After discussions with the patient and her nurse practitioner, a medication plan was created for the patient to follow.