Care Transitions

A new phrase has entered the pharmacy lexicon: “transition of care.” What does this term mean and how does it affect the pharmacy community? I would like to explore these questions.

I had a conversation recently with a hospital pharmacy director who said that a great deal of her time was focused on ensuring a smooth transition in the care process, especially in medication therapy when a patient was being admitted to or discharged from the hospital. She stated that this term, “transition of care,” was just another way of expressing the goal of continuity of care—a concept she said I used to talk about when I taught hospital pharmacy. I will leave it to someone else to decide if these concepts are identical, or if “care transition” is a component of ensuring “continuity of care.”

What is obvious is that everyone, from payers, to providers, to patients and regulators, is concerned about safe and effective transitions when a patient moves from one health care setting to another. There are probably many reasons for this interest, but a major reason is that more problems occur at this juncture in the care process than any other—and these problems can be costly and dangerous for the patient. Thus, everyone is focusing attention on care transitions to save money and to keep the patient safe.

While attending a meeting recently, I asked an independent pharmacy owner how his daughter was doing now that she had graduated and returned to his pharmacy to work. She had taken one of my courses and had talked about how excited she was to put some of her training into practice in a community pharmacy. As her father responded that she was doing well, you could tell by his voice and countenance that not only was he a proud dad but he was pleased that she was bringing real innovation to their pharmacy practice.

The pharmacist went on to describe a new program which his daughter was taking the lead to implement. They had approached a large physician practice group in their community with a proposal to work with them to help manage the patient care process when their patients are discharged from the hospital to return to their home or another facility. He mentioned how receptive the medical group was to this request because they were being evaluated by how well patients did during these transitions. The doctors viewed the pharmacy help not as a cost, but as a tool to improve reimbursement. He went on to suggest that he and his daughter plan to expand this program to other practices and even the local hospital.

This type of program is not unique only to a small town in rural North Carolina, as pharmacy owners work to improve health care in their communities. Many chain pharmacies have also moved into such programs; recently, the Walgreens WellTransitions, a coordinated care program, was endorsed by the American Hospital Association.

“The Walgreens WellTransitions program will serve as another tool for hospitals seeking to reduce readmissions and support overall community wellness,” stated Anthony Burke, president and chief executive officer of AHA Solutions. “We have endorsed this program for the broad scope of services that are provided through Walgreens’ extensive network of pharmacies and pharmacy services.”

The message I hope you get from my commentary is that there is great opportunity for community pharmacy, but it will take “transformative thinking.” This idea was described by RADM Scott F. Giberson, acting deputy surgeon general, in a recent article (Am J Health-System Pharmacists 70:1601-1604, September 15, 2013). Here he says, “Transformative thinking does not mean simply thinking of a way to add more detail to what we are already doing or adding more constructs to seemingly improve an established baseline. Transformative thinking means we must also try to advance our practice, not just improve it, for the benefit of the nation’s health.”

Those community pharmacists who have become engaged in helping patients manage care transitions are engaging in transformative thinking. Are you one of these?

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is interim executive director of the North Carolina Association of Pharmacists.