Pharmacists Studying Transitions of Care in an Emergency Department Population

A recent Community Pharmacy Foundation (CPF) project, entitled “Evaluating Older Adult Perceptions of Community Pharmacists and Provided Services as an Aid to Emergency Department Transitions of Care,” was halted due to the COVID-19 pandemic. Team members included Cara Hoyt,PharmD; Danielle Kieck, PharmD; Kristen Merz, PharmD; Brianne Porter, PharmD, MS; and Lauren T. Southerland, MD. Participating facilities were Uptown Pharmacy in Westerville, Ohio, and Ohio State University East Hospital emergency department (ED).

The team had worked together on a previous CPF project, which was published in the American Journal of Emergency Medicine in March 2019. In this study, the researchers found that although pharmacists and home health nurses could be a valuable part of a team during transitions of care, patients were not open to their assistance, primarily due to feelings of loyalty to their usual pharmacy closer to home.

“Low recruitment in the first study and the realization that patients were loyal to their pharmacy, and specifically their pharmacists, provided us with a lot of insight,” Brianne Porter, PharmD, said. These insights motivated the group to better understand the relationship with the community pharmacist to build relationships during transitions from the hospital to home and strengthen the relationship between EDs and pharmacies.

Porter said that they planned to interview patients after emergency visit discharge to see whether they filled prescribed medications. If so, they would delve more into the experience of that transition home, the pharmacist’s role in the process, and the patient’s overall expectation of the pharmacist. They wanted to know what was the pharmacist’s role in transitions of care? How did that help the patient feel cared for, and did that impact loyalty to the pharmacy?

Lauren T. Southerland, MD, explained that recruitment for this study had just started, but the COVID-19 pandemic was a limiting factor. Hospital staff had to stop all research activities as the focus shifted to COVID-19 and studies relating to the pandemic.

Although the researchers could not complete their project as planned, they still learned a great deal from their experiences and reflection, much of which pharmacists can apply in their practices.

Porter said, “It is important to understand other viewpoints, taking the time, especially in small communities, to reach out to the emergency department. Try to meet the staff, ask questions, find out what they struggle with—how can pharmacists help?”

Southerland explained that in the ED, patients often assume their electronic medical record is up to date, when it usually lists medications that the patient discontinued years ago. Pharmacists can provide a helpful service by giving patients up-to-date paper copies of medication lists. She also suggests that when pharmacists see prescriptions that come in from an ED, it is a good idea to talk to the patient to ensure they understand what the medications are for and if there are any questions.

Cara Hoyt, PharmD, reiterated the importance of developing solid relationships with patients, so they are comfortable asking questions and trust pharmacists with their care.

“Try to go the extra step, talk to the patient, and help them understand their transition of care,” she said.

Acknowledging that time is a constraint in the community pharmacy setting, Hoyt suggests pharmacists can help patients by thinking about what resources we can equip patients with proactively, such as medication lists.

“Additional services to consider include medication synchronization and medication therapy reviews,” Hoyt said. “The more we go above and beyond, the more we can help.”

Porter reminds pharmacists that sometimes ED providers need to call the pharmacy for clarification and to be receptive to these calls.

“Remember that they are trying to take care of the patient and to be helpful and give them clear information,” Porter said.

Dr. Southerland added, “And vice versa...I know it’s hard to call the ER, but I’ve never had a pharmacist call with a bad question.”

She suggests that, when possible, pharmacists establish communication with the ED staff. Dr. Porter reminds pharmacists, “Communication is always key...there are many pharmacies in comparison to the number of hospitals—it’s incumbent upon us to reach out to ER doctors and create relationships.”

Last but not least, Southerland suggests, “If your pharmacy does something special, like vaccines, compounding, or TED hose, let providers know.”

Community pharmacies have a number of patient care services they can offer. Dr. Hoyt suggests a call to action for pharmacists.

“Focus on patient care and helping patients achieve better health outcomes based on the needs in your communities,” she said.

The Community Pharmacy Foundation (CPF) funds innovative ideas to advance the practice of pharmacy in the community setting. CPF is committed to transforming community-based pharmacy practice beyond filling prescriptions to a focus on providing patient care as a founding sponsor of the nationalFlip the Pharmacy program.