Mission: Prevent Lapses in Care

from my story at Academic Pharmacy Now

The more than 1,200 recently hospitalized patients had been discharged and sent home. For many, it was a time of confusion and uncertainty: patients missed taking their medications or were uncertain about their dosage, had been reluctant to make follow-up appointments and also may have wondered if a return trip to the hospital was in their near future.

One by one, these patients were getting phone calls from about two dozen University of Buffalo School of Pharmacy and Pharmaceutical Sciences fourth-year advanced pharmacy practice experience (APPE) students who worked vigorously to prevent lapses in care. The calls lasted only a few minutes, but the discussions were focused and powerful for the patients who had complex medical histories. The student pharmacists asked questions before the calls ended: Did they understand what their medications were for? Did they know the kind of diet they were on? The callers counseled patients and urged follow-up care with their doctors.

After many months of working with the patients, there were huge successes, including a significant reduction in the number of patients returning to the hospital as readmissions within 30 days. Of 1,200 patient encounters examined, 67 percent had decreased odds of all-cause 30-day readmissions and decreased odds of related readmissions. The program included patients contacted from June through November 2017.

The outreach by these student pharmacists working in tandem with community pharmacists made a “significant impact on reducing hospital readmission rates,” according to a study of the program published earlier this year by the Journal of the American Pharmacists Association.

“Post-discharge follow-up by community pharmacists has the potential to dramatically affect the rate of 30-day hospital readmissions,” the study noted. “Integration of student pharmacists or residents can provide a low-cost strategy to facilitate implementation and expansion.”

That period between the time when patients are discharged from hospitals and the time they are recovering is sensitive, wrought with potential problems. The transitions of care (TOC) stage is a continued target in a burdened healthcare system in the effort to reduce costs and improve quality.

Student Pharmacists Smoothing Transitions

Transitions of care are well documented as one of the most vulnerable times for patients, whether they experience a medication error, adverse event or other complications, the researchers said. And high readmission rates have imposed a significant clinical and economic burden on the U.S. healthcare system. About 20 percent of Medicare patients are unexpectedly readmitted within 30 days of hospital discharge, amounting to a cost of $41.3 billion, according to figures reported in 2011. The result also could be huge penalties against hospitals.

“Transitions of care is something we’ve been developing the past four or five years, how pharmacists are impacting transitions of care,” said Rebecca Brierley, assistant dean of external affairs, director of communications and alumni relations for the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. “We are doing some creative things within the TOC model and are excited to share with the academic community.”

Dr. Amy Shaver, now a post-doctoral research fellow, was in rotation at the High Street Prescription Center as an APPE student and became curious about the TOC program at the pharmacy located in the lobby of the hospital. She thought it was terrific but wondered what kind of data was behind it. It was then she began working on the study along with other officials.

“They had this wonderful program that on its face looked like it was helping people, but they had no proof and I didn’t know it was statistically significant,” Shaver said. “You could tell they were doing good but you couldn’t prove it unless you studied it. I already completed my MPH and had a feel for study design and thought we should publish this.”

The Buffalo study demonstrates the role that student pharmacists can play in multifaceted transitions of care plans, university officials said. “To our knowledge, this is the first published study to evaluate the impact of a TOC program that is driven primarily by APPE-level student pharmacists. The use of student pharmacists is a low-cost and effective strategy for staffing a TOC program,” according to the study.

Using one to three APPE-level student pharmacists working full time on the calls, at an average of less than five minutes each, “allowed for a further-reaching intervention than would have been possible” with a TOC pharmacist alone, which contributed to a significant reduction in readmission rates, researchers added.

The students’ phone calls were made to patients within two to seven days after discharge and focused on medication counseling as well as promoting physician follow-up visits. Although the length of calls ranged from one to 40 minutes, the average counseling session required less than five minutes. The pharmacists worked with outpatient providers to resolve any medication-related problems such as inappropriate therapy, duplicative therapy and potential drug interactions. Patients were also advised to schedule post-hospitalization follow-up appointments as recommended in their discharge paperwork. A TOC pharmacist was available to answer questions or concerns raised by the student pharmacists.

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