Community-Retail Pharmacist Decreases Hospital Readmissions

The scenario goes something like this: on a Friday afternoon, a patient is discharged after an extended stay in the telemetry care unit of the local community hospital. The patient is sent home with a prescription for one of the new oral anticoagulation or antiplatelet medications, among other medications. The patient's spouse goes to the local community pharmacy to pick up the prescription, only to find that it is not covered by the patient's insurance, and the cost is in excess of $200 for a 1-month supply of this new treatment.

Furthermore, the prescription was written by the hospitalist, who has already left the hospital and isn’t in the position to do the prior authorization paperwork with the patient's insurance company. The patient has a follow-up appointment with his primary care physician next week; however, that doesn’t help with the need for the current prescription today.

What is the patient to do?

• The patient may purchase the prescription with out-of-pocket funds.
• The pharmacy may forward the patient some meds; however, there is no guarantee they will get covered within the next 4 or 5 days.

Most likely, the patient will go without until he, or the pharmacy, is able to contact his primary care physician the next week and explain the situation. Unfortunately, in this scenario, the patient runs the risk of developing a clot and returning to the hospital for further treatment.

The community hospital that I work at has developed a program to address this very issue. Interestingly enough, administration did not come to pharmacy asking for us to develop this program; rather, it was developed by one of the staff outpatient pharmacists and presented to administration. This particular program was refined and presented again and again over an 18-month period until it was approved for a 6-week trial. Presently, the program has been in place for 12 weeks.

As we know, different pharmacists maintain and develop different skill sets. As community retail pharmacists, one of the skills we develop is the ability to see a prescription and have a relatively good idea if it will require prior authorization from a patient's insurance. With this in mind, one of the pharmacists from my hospital's outpatient pharmacy is invited to come into the hospital and sit in on rounds every morning, Monday through Friday.

The pharmacist is allowed 60 minutes to review the 60 to 70 charts, looking specifically for new medications that may be difficult to fill upon discharge. Currently, the hospital pharmacy budget covers the pharmacist's time in the hospital, and the outpatient pharmacy is back-filled through a hospital pharmacist rotation cycle.

In our facility, rounding for the telemetry care and med/surg units lasts about 60 minutes and includes 3 or 4 RN case managers, social workers, charge nurses, a physical therapist, a community placement coordinator, a DRG coordinator, an administration representative, and now, an outpatient pharmacist. Each of the 8 hospitalists come in and discuss, in rapid-fire manner, each of their patients, with an emphasis on their discharge plan.

When a patient is identified as having a new medication that may be difficult to fill upon discharge, the pharmacist will speak up, with an effort to help coordinate the filling of the particular medication. Quite often, this involves obtaining a discharge prescription order from the hospitalist for the medication up to 48 hours prior to actual discharge. The pharmacist is then able to work with the RN case manager and the patient’s insurance company to fulfill any prior authorization requirements in time for the patient to take the medication home upon discharge from the hospital.

During the first 10 weeks of service, the pharmacist helped coordinate the filling of 60 medications that may have been difficult to fill in the community. We have not yet performed the retrospective analysis to determine the impact this has had on the hospital's readmission; however, the medical staff and RN case managers are delighted with our service.