Ed. Note: This is the fourth in a series of posts that will discuss and share best practices related to transitions of care and preventing readmissions utilizing an easy-to-follow Top 5 format. Please check back weekly for updates, or follow us on Twitter at http://twitter.com/careteamconnect to be notified when new entries are published.
Author: Bill Brody
The recent launch of Partnership for Patients is the latest example of what has become a recurring theme in healthcare: Better Care, Lower Costs. A central tenet of these conversations is the interwoven relationship between hospital readmissions and adverse drug effects (ADEs), and the tremendous cost both in human and financial terms. In February 2011, NEHI (New England Health Care Institute) issued a health policy paper that identified $21 billion in health care costs associated with medication errors in both the outpatient and inpatient care and $25 billion in hospital readmissions. Nearly 8 million Americans were significantly impacted by what essentially boils down to poor medication management in the inpatient, outpatient and transitions of care environment.
Today, in a familiar format, we are taking a closer look at the important role pharmacists play in patient follow up, patient safety and reducing the cost to care while improving outcomes, and why they should be an irreplaceable member on any solid care team.
1. Better living through chemistry – I didn’t pull numbers on this (although if I turn some up subsequently I will link them in) but asserting that a very high percentage of patients discharged from the hospital are in possession of at least one new or changed prescription seems like a safe statement. And a new prescription means a new regimen means new potential for adverse drug effects. En masse. Pharmacists kept busy filling all of these prescriptions also need to be on alert for contraindications.
2. Something for everyone – Often times patients lack the means to pay for the medications required to treat their chronic condition. With polypharmacy becoming increasingly more prevalent it follows that the risk of non-compliance due to socioeconomic factors rises as well. A pharmacist following up with a patient can assess this situation and offer options, such as a less costly generic alternative. By engaging a pharmacist as the point person on medication, these kinds of factors are no longer such great obstacles.
3. No habla farmacia – Translation: “I can’t understand the complex instructions you are putting in front of me in good times, let alone immediately after a traumatic experience.” It wouldn’t surprise me if patients viewed selecting the right medications from their crowded medicine cabinet much in the same way an amateur crime fighter would view defusing a bomb. “If I pull out the red one, what will happen?” Pharmacists following up with patients are well-positioned to answer any medication questions that emerge post discharge, when the patient has attempted to return to a semblance of normalcy and routine.
4. Out with the old, in with the hospital – In medication regimens, much as in life, our pasts come back to haunt us. Patients on one type of medication prior to hospitalization need to have their history considered when new medications are prescribed. Unfortunately, this is often compromised. Med reconciliation based on inaccurate or incomplete information happens too frequently, with ADEs frequently the result. Pharmacists are specially trained to evaluate the potential for adverse drug interactions, so giving them omniscience over a patient’s prescriptions helps combat this. Pharmacists also may have access to a community pharmacy record and/or have the time to walk through all the medications in a patient’s possession, either in person or over the phone. This is especially important in today’s day and age of siloed care, where a patient may see a large number of doctors in a given treatment period. Pharmacists oftentimes end up the links in a chain of care.
5. Pencils have erasers, people do not – Sooner or later all of us will require medical attention, and when we do, most of us place our faith in doctors and hospitals to be a solution to our health problems, not an exacerbation of them. Covering skyrocketing costs has been done to death, but it’s important to make a distinction between the costs incurred treating patients (inevitable) and the costs incurred performing damage control. The aforementioned NEHI study identified at least $21 billion in damage control, and probably more depending on how you feel about the readmissions figures. To a program (CMS) spiraling towards insolvency that’s a huge deal. Greater pharmacist involvement can only dramatically chip away at that number.
In the coming months we anticipate that more and more thought leaders will come to see pharmacists as indispensable members of the care team, and community initiatives already underway will start to incorporate both local pharmacies and the large chains into their careful planning for the future.
How about you? Any examples of pharmacists playing a crucial role in care transitions in your community? We’d love to hear from you on this or anything else related to care coordination. Drop us a comment below and we will be in touch.
Please also register for our free webinar on July 28, where we are turning the microphones over to our clients so that they can discuss Case Examples of Care Coordination Programs in Practice Today. You can register right here.
