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A new spin on transitions of care: Pharmacists bridging the gap between inpatient and outpatient settings
Author(s) -
Leistman Samantha,
Nagel Angela K.,
AhmedSarwar Nabila
Publication year - 2020
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1305
Subject(s) - pharmacist , medicine , ambulatory , emergency department , ambulatory care , psychological intervention , emergency medicine , intervention (counseling) , clinical pharmacy , health care , acute care , family medicine , pharmacy , nursing , economics , economic growth
Benefits of pharmacist involvement during transitions of care (TOC) are well validated in the literature, but this role remains highly variable and institution specific. The purpose of this study is to describe the impact on acute health care utilization and overall patient outcomes when a pharmacist is added to a unique TOC team that encompasses both ambulatory and acute care settings. Methods This study is a retrospective review of an established TOC service that recently added a pharmacist. As part of this service, patients meeting prespecified criteria received pharmacist intervention during inpatient rounds and discharge follow‐up visit(s). The primary outcome was the change in number of acute health care encounters (emergency department [ED] visits and/or hospital readmissions). Secondary outcomes included type, frequency, and duration of patients' health care encounters, reason(s) for readmissions/ED visits, clinical pharmacist interventions, and changes in disease state‐specific outcomes. Patients served as their own control and results were compared between the 6 months prior to and after initial pharmacist intervention. Results In total, 44 patients were included. In the 6 months following initial pharmacist intervention, total number of acute health care encounters decreased by 39.5% ( P < .001). Among patients readmitted or seen in the ED after initial pharmacist intervention, 28.3% occurred within 30 days of hospital discharge. Acute health care utilization was considered preventable in seven (29.2%) hospital readmissions and three (13.6%) ED visits. Average time between admissions increased by 6.6 days ( P = .020). Provider‐pharmacist discharge co‐visits were completed for 75% of patients and a total of 182 pharmacist interventions were performed. Median time to first discharge follow‐up visit was six days (interquartile range, 4‐8). Conclusion Incorporating a pharmacist into an established TOC team, working across both the inpatient and outpatient settings, resulted in a significant decrease in number of acute health care encounters per patient and increased time out of the hospital.