Pharmacists Critical to Transitional Care Teams for Geriatric Patients

Pharmacist involvement on care teams for geriatric patients transitioning out of emergency departments may still be undervalued.

Within 6 months of acute hospitalization, 30% to 50% of older patients experience a loss of essential activities of daily living, while 20% to 30% are readmitted, and another 20% to 30% die.

A new study published in JAMA Internal Medicine investigated whether a comprehensive geriatric assessment combined with a transitional care bridge program could improve outcomes for older adults who are acutely hospitalized.

Of note, neither the assessment nor the transitional care program directly involved a pharmacist. Rather, a geriatric-trained registered nurse conducted the comprehensive geriatric assessment, while the transitional bridge program to discuss treatment plans was conducted by a community care nurse, the patient, and the patient’s caregiver.

The transitional care bridge program intervention was initiated during hospitalization through a visit from a community care registered nurse and continued after discharge with home visits at 2 days and at 2, 6, 12, and 24 weeks. During these visits, the community care nurse performed reconciliation and was instructed to contact the patient’s general practitioner in case of problems with medications or geriatric conditions.

Despite this, the study’s “systematic [comprehensive geriatric assessment] followed by the transitional care bridge program showed no effect…in acutely hospitalized older patients,” the authors found. Perhaps the patient outcomes would have improved if pharmacists were more integrally involved in transitional care teams.

Lead study author Bianca M. Burrman, RN, PhD, told Pharmacy Times that she could “definitely see” how a pharmacist “can play an important role in the medication review at admission and also provide advice with regard to medication [and] which should be continued or stopped.”

“We observed that although medication reconciliation is standard practice, many older patients had bags with medications at home,” she said, adding that it often wasn’t clear which care setting supplied the prescriptions and whether the patients should still have been taking them.

In order to optimize care for geriatric patients, Dr. Burrman advised pharmacists to “provide information in writing and verbally explain it,” given that “many patients have cognitive impairment at admission and recall of information is limited when only providing it verbally.”

Such communication barriers can potentially lead to delays in care or excessive care, both of which can result in negative patient outcomes.

In a separate study, researchers from the University of Maryland surveyed health care professionals working in geriatric emergency departments to investigate potential barriers to better communication.

These researchers identified the following crucial roles that pharmacists can play to help narrow communication gaps:

1. Prevent adverse drug events associated with emergency department admissions.

2. Optimize medication regimens to prevent disease progression or exacerbation.

3. Perform medication reconciliation upon all transitions of care.

4. Facilitate communication with outside care providers to ensure quality of care for residents.