Pharmacy Times interviewed Jennifer Winters, PharmD, MBA, CSP, and Abby Cypher, PharmD, who work in outpatient services at Allegheny Health Network in Pittsburgh, Pennsylvania. During the discussion, they highlight the Meds-to-Beds program, a transitions of care program designed to enhance medication adherence by providing patients with their prescribed medications prior to leaving the hospital. They discuss the role of the pharmacist within this program, how they collaborate with other health care professionals, and the importance of the relationship between pharmacists and patients.
Key Takeaways
- Addressing Medication Adherence: Meds-to-Beds is a transitions of care program focused on enhancing medication adherence by providing patients with their prescribed medications before leaving the hospital. The program addresses various adherence barriers, including high medication costs, formulary issues, and potential prescription errors, aiming to mitigate up to 33% of medication-related hospital admissions attributed to patient nonadherence.
- Positive Patient Responses and Outcomes: Patients respond positively to Meds-to-Beds, noting the convenience of receiving medications bedside before discharge, eliminating the need for additional pharmacy visits, potential errors, and ensuring a smoother transition from inpatient to outpatient care. The program also contributes to successful patient outcomes, fostering satisfaction and compliance, with pharmacists playing a crucial role in educating patients, addressing concerns, and ensuring a comprehensive understanding of prescribed medications.
- The Pharmacist’s Role and the Collaborative Approach: The implementation of Meds-to-Beds was a collaborative effort involving pharmacists, nursing staff, social workers, case management, providers, and other stakeholders. The program is an integral part of the care team and helps physicians ensure patients receive appropriate and cost-effective medications. Pharmacists actively engage in the program by enrolling patients, reviewing prescriptions, conducting cost checks, and addressing potential barriers to adherence.
Pharmacy Times: Can you give an overview of the Meds-to-Beds program and how it is implemented?
Jennifer Winters: So, Meds-to-Beds is a transitions of care (TOC) program where a patient who's discharging from the hospital to home can receive their medications prior to leaving the hospital. At its core, Meds-to-Beds is really a medication adherence program, so the practice of professional pharmacy has been very involved with an adherence for, I would say the last 20 years. Many, many articles have touted the importance of med adherence and there have been statistics stating that, up to 33% of medication-related hospital admissions are because of patient nonadherence. There's also a dollar value assigned to patients being nonadherent to their medications, so in answer to some of that data that was coming out in the early 2000s, health systems across the nation really started to look at how can we help our patients become more compliant when they're prescribed the medication, that's often when they're impatient, or getting ready to be discharged.
So, in answer to some of those issues, some of those medication adherence barriers and statistics, Meds-to-Beds became a program that became very popular across the nation. So, some of those barriers that Meds-to-Beds can help with would be anything from a patient getting a medication that is high cost, a medication that may not be formulary, on their outpatient prescription plan, prescription error that might not be detected, or would be detected easier before they leave the hospital. So Meds-to-Beds really tries to bridge that gap for patients from inpatient to outpatient, and help that transition be a smooth process for the patient.
Pharmacy Times: What is the patient’s overall response to Meds-to-Beds, and can you share any outcomes of the program?
Abby Cypher: The patients have been, on the most part, are very receptive of the program. It allows us to deliver the medication bedside prior to them leaving the hospital, so it allows us to make sure they are leaving with a medication that is not a cost burden to them, making sure that they don't have to stop at an additional pharmacy on the way home from getting their medications, and like Jennifer said, when you're talking about prescriptions and fixing different errors and whatnot, we've already addressed those so they don't have to go to an outside pharmacy, then have the physician paged, wait for that page to come back, and then a lot of times they would leave, leave that pharmacy and maybe not get their medication. So, they are very happy—I believe—to have their medications delivered bedside in a complete form, comfortably knowing they just have to go home, rest, and they have what they need.
Pharmacy Times: Was the implementation of the program pushed by pharmacists, or was it a broader, more collaborative effort?
Winters: So, when we first launched Meds-to-Beds, it was an extremely collaborative approach. Obviously, we had a pharmacist that went up to the hospital floors to do initial education, but we really tried to pull in the nursing staff that were seeing the patient firsthand, like every VR for med passes, and then also the discharge education. We also pulled in social workers, case management, providers, doctors, residents, everyone has a stake in making sure that the patient continues to get what they need after they leave the hospital and have a continued recovery. So, Meds-to-Beds helps each 1 of those stakeholders in a different way and really introducing what Meds-to-Beds can do for the different clinicians in the hospital, but also the patient, was a really valuable aspect of the launch.
Cypher: And to add to that, after all of that groundwork, and footwork was laid [out], sometimes it takes [people] a hard time to adjust to new things, but now that the program is up and running and moving and has proven to be a successful part of TOC, physicians almost expect that. They know that they can come to us, they [know] we can do price checks for them, we can do different sorts of formulary checks to help them and just double check their work so that they can rely on us and aren't getting phone calls and inundated with pages and whatnot from other pharmacies. So, it is very, very accepted now as a collaborative assignment and discharge that Meds-to-Beds as part of that.
Winters: Yeah, it's helped make the retail pharmacies part of the care team in the health system.
Pharmacy Times: What is the pharmacist’s role in this program, and how might pharmacists collaborate with other health care professionals?
Cypher: Sure, so our role in the process is, we actually do get to see patients’ charts, we enroll them in the program after speaking to them to make sure it's something that they're aware of and they want to participate in. We receive prescriptions from the physicians during the patient's stay, we work on those prescriptions, again, to make sure there are no cost barriers, make sure there's no interactions, make sure that formularies are met. Even if we have coupons to run for patients, we have a little bit of time to do that, meaning if they were going home on a starter dose pack of [a medication], we're able to get them a coupon so they leave the hospital with at no cost to them for that medication. Our role is really just making sure that the patients’ needs are met, and that we are doing what we can for them for it to be a successful transition.
Pharmacy Times: In what ways does Meds-to-Beds develop the relationship between the pharmacist and the patient?
Winters: Historically, I think that the relationship between pharmacists and patients has been 1 of the most trusted in the health care setting. I think that the Meds-to-Beds program continues to propagate that. So, pharmacists are talking to patients as they get ready to discharge, making sure that they have what they need, making sure that it's affordable for the patient, asking the patient if they're having issues with adherence or access to medication, [having] those conversations that continue to build inroads with patients between patients and pharmacists. And it's so important that that relationship is there and then it segues into the community, into making sure that patients continue to have good relationships with their community pharmacist because of the work we're doing on the outpatient side in the hospital.
Pharmacy Times: Any closing thoughts?
Winters: For me, working with the Meds-to-Beds program has been a very rewarding aspect of my career. I think that I see the good that it's doing for patients that are discharging, but also how it helps providers and the care team on the inpatient side. How it has allowed retail pharmacy to interact in a very transparent way during the discharge process has been really rewarding.
Cypher: I would second that, I think before I came to [Allegheny Health Network], I wasn't [in] a traditional retail setting, and just [seeing] the frustration on some people's face when they come in because they don't know how to use their insulin pen, or they don't know how to use an inhaler, or they don't know how to use the machine, and you want to try your best to help them to learn to do those things. That's something that with Meds-to-Beds, they're already going home knowing how to do that, they're already set up for success. So, it's nice to be in a retail setting where you truly make an impact in patient care by helping to do those educations bedside, face-to-face with the patient in a calm environment. So, I would second that the reward and helping patients is very exciting.
