Collaboration Between Community, Hospital Pharmacists Central to Reducing Hospital Readmission Rates

Community pharmacists play an integral role in reducing hospital readmissions when they partner with area hospitals to assist with transitions in care, according to a presentation at the National Association of Chain Drug Stores (NACDS) Total Store Expo held in San Diego this week.

Stacey Frede, PharmD, BCACP, CDE who is manager of Clinical Program Development for The Kroger Company and Eric Wright, PharmD, MPH who is co-director of the Geisinger Center for Pharmacy Innovation and Outcomes, both addressed this topic at the meeting.

While building the relationships between hospitals and community pharmacists can be difficult, the benefits are far-reaching, Frede said.

“The current trend leaves the patient out on their own [after being discharged from the hospital],” Frede said. One-fifth of Medicare patients are readmitted to the hospital within 30 days of their discharge, at a cost of $25 billion per year, according to Frede.

Community pharmacists can play a major role in reducing those rates by linking with hospitals to ensure a smooth transition occurs once a patient leaves the medical facility. Pharmacists know their patients, Frede said, adding that many community pharmacists serve at-risk patients in areas where readmission rates are the highest, she noted.

“There’s a huge need to address the issue of readmission to the hospital,” Wright said, adding that patient readmission can be prevented. “Two-thirds to three-fourths [of hospital readmissions] are preventable. The vast majority are related to medication.”

Wright said his organization conducted the Gesinger Initiative to examine the practicality of linking inpatient pharmacists to outpatient pharmacists using technology, streamlining the process to better serve high-risk patients while reducing the rate of hospital readmission. A more connected process could eventually drive down medical costs among high-risk patients, Wright noted.

The Geisinger Initiative followed patients with a mean age of 67 from December 2014 to September 2016. Patients often had several comorbidities including, heart failure, diabetes, chronic obstructive pulmonary disease, and pneumonia and an average hospital stay of 5 days. At the time of discharge, patients typically left with 19 medications.

The patient discharge process is often chaotic, leading to patient confusion regarding medications prescribed by hospital pharmacists. As part of this initiative, patients receive an inpatient pharmacist medication counseling prior to discharge, followed by a secure message that is then sent to the community pharmacist. The community pharmacist can then follow up to ensure the patient is taking their recommended medications. Wright noted the ideal initial patient contact following the hospital discharge is between 1 and 3 days.

“Having the patient engaged when they are not in a high-stress environment was something we were looking forward to,” Wright said, adding that the focus should be on patients who are high-risk with medication-related problems and previous hospital visits.

While the Geisinger Initiative’s preliminary findings demonstrate that the process is feasible, only 40% to 61% have a note (or communication) sent to the community pharmacist, according to Wright. He noted that study’s findings indicate interest in the health care community to expand the role of the pharmacist/pharmacies through collaboration. He explains more in the video below:

He indicated further findings of the study are expected later this year.

“We’re in a position to reach out to community partners because we’re all facing the same problem,” Wright said, noting the issue of patient readmission is a common problem facing the medical community.

Frede said that officials with Kroger set out to study the impact of a 2 hospitals and 9 pharmacies partnership in the Cincinnati area that aimed to decrease the 30-day readmission rate. Frede said that while they saw positive results, the study pointed out some issues with streamling technology that need to be addressed, she said.

“We’re looking for this to be the new normal,” she said, adding that the process could be streamlined by utilizing a standardized documentation form to ease the procedure for enrolling patients. “Pharmacists would be able to make more of an impressive intervention because they would have all that data. It’s important for us to close the gaps.”

Reference

Frede S, Wright E. Transitions of Care: Collaborative Care to Reduce Hospital Readmission Rates. Presented at: NACDS-TSE; August 19-22, 2017; San Diego.