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Transition of Care: Why Aren’t Pharmacists More Involved?


April 17, 2014

Nearly all of the pharmacy directors who responded to a recent survey believed pharmacists should be more involved in the transition-of-care (TOC) for hospitalized patients. So why aren’t they? 

Researchers in the pharmacy department at the Henry Ford Hospital in Detroit teamed with the American Society of Health-System Pharmacists to collect online survey responses from nearly 400 pharmacy directors.

According to the survey, 43% of pharmacists were not involved in TOCs within their hospitals. Only approximately a quarter of respondents were involved with reviewing physicians’ discharge medication lists, patient counseling, medication reconciliation, and coordination of follow-up care at anticoagulation clinics. Nearly three-fourths of the pharmacists said they spend less than 4 hours of a 40-hour workweek on TOC activities. Respondents also said only 30% and 14% of pharmacy students and pharmacy technicians, respectively, were involved with TOCs.

Most respondents said a lack of pharmacy staff resources limited their involvement in TOCs. Notably, 40% said the executives, nurses and medical staff at their facilities didn’t fully appreciate the value of pharmacist involvement in TOC activities, even though medication errors and adverse medication events often occur when patients move between different locations or levels of care.

The researchers noted that pharmacists are “uniquely qualified to identify and resolve medication-related problems” and have diverse, but limited roles, in TOCs. They offered several recommendations to get pharmacists more involved in frontline care.

First, pharmacy directors should ensure pharmacists or members of the pharmacy staff obtain accurate medication histories and resolve medication-related issues when patients are admitted as inpatients or outpatients, so accurate medication records follow patients throughout the continuum of care.

Second, pharmacists should include problems related to medications in discharge summaries, and communicate those challenges to pharmacists in the outpatient setting to optimize chronic disease management and reduce adverse events that overload healthcare resources.

Third, pharmacy residents need to be exposed to improving TOCs in the outpatient setting in order to better train them for the future of the profession, which will demand more management of chronic conditions.

Finally, pharmacists should document in patients’ charts recommendations for optimizing drug therapies for all chronic diseases, not just for anticoagulation and heart failure, as is the current standard.

“Though practices vary throughout the country, I believe it’s important that all pharmacists and pharmacy departments begin to ask themselves how transitions of care can be incorporated into daily practice — even if it has to be done without extra resources,” said study lead author Dr. Nadia Haque, pharmacy manager at Henry Ford Hospital.

She added that pharmacists should advocate for medication management and are uniquely positioned to gather the most information about patients’ drug therapies. “All pharmacists should make transition of care a priority for every patient,” she added.  “This can include medication reconciliation, patient education, discharge medication recommendations, and providing appropriate referrals for follow-up care.”

The study was published in the American Journal of Health-System Pharmacy.

 

—Dan Cook

 

Reference:

1. Kern KA, Kalus JS, Bush C, Chen D, Szandzik EG, Haque NZ. Variations in pharmacy-based transition-of-care activities in the United States: a national survey. Am J Health Syst Pharm. 2014;71(8):648-656.

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