The patient goes home: Pharmacists and transitions of care

April 10, 2015

A word from the Honest Apothecary: Guest columnist Jason Poquette spells out what transitions of care actually involve.

Jason PoquetteIn the March 2015 edition of Drug Topics, pharmacist Salvatore Giorgianni called upon pharmacists to take up the challenge of helping patients who are experiencing what is now commonly referred to as “transitions of care.”

See also: Transition of care: The challenge for pharmacists  

As a pharmacist working on the front lines of one of the most common points of transition (from hospital to home), I want to echo his message and provide additional details about an area of focus not often considered by community pharmacists. Due to the enormous impact of insurance penalties for hospital readmissions, transitions of care are a critical area of focus for healthcare institutions and practitioners.

Pharmacists, especially those working on either side of the transition, need to be aware of this enormous opportunity, the obstacles, and a plan to help.

See also: The pharmacist's role in transitions of care

Opportunity

The opportunity presented by transitions of care is evident if we simply take a moment to consider the magnitude of changes that occur when, for example, a patient moves from a hospital setting to home. There are at least four major transitions that patients immediately may experience when leaving the hospital:

  •  Transitions in service access. The patient will no longer have virtually immediate access to necessary healthcare services related to his/her condition, such as important lab work, blood samples, monitoring, and dietary services. 

  • Transitions in caretakers. Generally, the patient will no longer be surrounded by trained medical staff, such as physicians, nurses, pharmacists, physical therapists, and aides. The patient’s care will often be self-conducted or assisted by loving, but not medically trained, family and friends.

  • Transitions in billing. In a circumstance often overlooked, the costs related to patient care will no longer be totally funded by the patient’s medical plan. Patients will now be subject to financial obligations such as copays and/or deductibles. In addition, their medication needs will now be managed by their pharmacy benefit, which may or may not provide coverage for what has been prescribed.

  • Transitions in medication. Very often, though not always, the patient will be going home with a new list of medications, which they now have to manage on their own. These medications will have their own new and unique dosing schedules and side effects.

When you pause for just a moment to think about how many things actually change for the patient who is experiencing one of these “transitions of care,” you come to realize that the term “transition” is perhaps the biggest understatement in medicine today. This also explains why this transition is so often complicated and sometimes unsuccessful.

 

Obstacles

Pharmacists who want to get involved to help patients manage their transitions of care will discover that their efforts are often impeded by many obstacles. In his article, Giorgianni asked, “Will we individually start to identify patients who need transition-of-care services?”

It is a good question, but it also presents a real problem. Identifying such patients, particularly in a community pharmacy setting, is not so simple as it may sound. It can be quite challenging. Patients do not show up at their pharmacies with tattoos across their foreheads that state, “I’ve just been in the hospital for two weeks - please help!” More often than not, these care transitions go entirely unreported and unsuspected by the community pharmacist.

A plan  

Pharmacists who want to engage this critical group of patients transitioning from the hospital to home will need to develop a plan. I agree with Giorgianni that we, as pharmacists, cannot depend solely upon our employers to take the lead.

There isn’t nearly enough time or space in a single article to expand upon the elements of a full-fledged plan for pharmacist-initiated patient-transition counseling and care. Success will depend greatly on pharmacists reaching out and coordinating with hospitals and providers, informing them of the additional patient-care services and counseling we are prepared to provide.

This cannot be done in a vacuum. We will need systems, tools, and best practices developed to meet the challenge and serve these patients well. 

Pharmacists can provide this level of service. The only question that remains is: “Will we do it?”

Jason Poquette is the director for outpatient pharmacy services at Saint Vincent Hospital in Worcester, Mass., and an APPE preceptor for the Massachusetts College of Pharmacy. Contact him atJason.pharmacist@gmail.com.