Ambulatory pharmacies help improve adherence, quality of care

Having an ambulatory pharmacy within a healthcare facility can assist discharged patients with their medication regimen and help to improve medication adherence. By increasing adherence, these pharmacies can also help reduce the number of readmissions and increase patient satisfaction, important factors outlined under healthcare reform.

"Three years ago we implemented a fully integrated web-based software program for retail ambulatory pharmacy care across our 12 outpatient pharmacies within the UW system," Rough said. Three of the pharmacies are located within hospitals and the rest are in physician office locations operated by UW, he said. The technology that UW uses allows each pharmacy to fill discharge prescriptions and have them brought to the patient's bedside by a pharmacist, who then counsels the patient about the medications. This is done a few hours before the patient leaves the hospital, a time that allows for better counseling than during the rush of discharge, he added.

The system reduces the readmission rate, makes patients happier, and captures the prescriptions for the UW pharmacies, Rough said. Refills can be provided by UW's own mail-order service, he added. "We want to keep these patients within our system forever."

Reducing readmission rates will be of growing importance, he noted. In 2014, hospitals will be hit with a 1% payment penalty by the Centers for Medicare and Medicaid Services if too many patients are readmitted within 30 days of discharge, a penalty that will rise to 3% in 2016, Rough said. There will also be penalties for poor patient satisfaction scores.

The integrated software program has improved efficiency at UW by 30%, Rough said.

A new frontier

"We believe ambulatory pharmacy is really the new frontier in hospital pharmacy," said Mark Eastham, RPh, senior vice president for pharmacy optimization with McKesson Health Systems, San Francisco. McKesson Corporation has created McKesson Pharmacy Solutions, a series of services to help hospitals establish ambulatory pharmacies that can capture new revenue, and improve efficiency and clinical outcomes simultaneously.

"We are guided by our customers and their particular situations," Eastham said. "They may already have an existing pharmacy up and running in some aspect. We can help them improve that." An ambulatory pharmacy would need some room for over-the-counter products that patients heading home from the hospital might need, such as bandaging or pain relievers, but would not need to sell cosmetics or similar items that a regular retail pharmacy would have, he explained.

An impact on quality of care

"The ambulatory space offers a lot of opportunities for a health system, opportunities that are probably more important than ever in today's world," said Christopher A. Borr, vice president of marketing for McKesson Health Systems. These opportunities are not just financial; an ambulatory pharmacy can increase the quality of patient care, he said.

Because the ambulatory pharmacy is integrated within the healthcare facility, the pharmacist who provides the consultation at the bedside has a complete overview of what the patient is being prescribed and why, and other aspects of his or her condition, Borr said. When the systems that keep the pharmacy connected to the patient – including follow-ups and reminders by phone calls, email, or text messages – are added in, the patient is less likely to end up back in the emergency room due to a drug mishap or because they didn't take their medications as prescribed, he said.

Patients who require specialized care would benefit most. "The classic patient might be a transplant patient that might be on a therapy for the rest of his or her life," Borr said. Because these patients often have follow-up visits to their physicians at or near the hospital, an ambulatory pharmacy has more opportunities to track them and keep filling their prescriptions.

Valerie DeBenedette is a medical news writer in Putnam County, N.Y.