Improving Care for Patients After Hospital Discharge

August 31, 2017

Who else besides pharmacists are better able to improve the care of patients at risk of medication-related problems after hospital discharge? Karen L. Pellegrin, PhD, director of continuing education & strategic planning at the University of Hawai`i at Hilo, Daniel K. Inouye College of Pharmacy, implemented a pharmacist-led transition of care program to enhance the medication management of high-risk patients.

The program, called Pharm2Pharm, was built around best practices of medication management and designed to give hospital and community pharmacists collaborative, integrated, and proactive roles in overseeing the medication routines of older, high-risk patients in order to prevent medication-related hospitalizations. During a 2-year stretch, the rate of medication-related hospitalizations among patients enrolled in the program was 36% lower than patients who did not receive pharmacist-led care.

Dr. Pellegrin recently took a few minutes to discuss the Pharm2Pharm program’s success, which was based on the knowledge and skills pharmacists bring to medication management and on providing community pharmacists with the information they need to identify and resolve drug therapy problems after patients leave the hospital.

How does the program work?

Hospital pharmacists review admissions on a daily basis using evidence-based risk criteria to identify high-risk patients. They then engage the patients in the hospital setting to work through medication issues before formally handing them off to community pharmacists. Hospital pharmacists prepare patient-specific information packets specifically for the community pharmacists, so the patient handoff is comprehensive and complete.

The goal of the program is to have community pharmacists see patients as soon as possible after discharge. We found that the program results in a significant reduction in medication-related hospitalizations among high-risk patients, and a significant return on investment in pharmacy services.

What components contribute to the program’s overall success?

It was implemented as a pharmacist-led service, not as a research project, so we were constantly looking for ways to improve the model. One of those key improvements was giving hospital pharmacists an added responsibility. While they screen newly admitted patients for enrollment in the program, they determine if readmissions of previously enrolled patients are due to potentially preventable medication-related issues, and treat those readmissions as quality-improvement opportunities.

The program also capitalizes on Hawaii’s statewide health information exchange network, which facilitates the transfer of patient information between hospital pharmacists and community pharmacists during transitions of care. The network helps hospital pharmacists, who have access to outpatient records when screening patients, and community pharmacists, who have access to lab results when they take over the care of patients. Community pharmacists must have real-time access to lab results and other clinical information from medical records in order to optimize medication regimens.

Interview continues on page 2