Pharmacist Advancement of Transitions of Care to Home (PATCH) Service

Abstract

Background: There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists.

Objective: To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs).

Methods: A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care.

Results: Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS.

Conclusions: Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

Keywords: medication safety; medication-related problems; pharmacist’s role; transition of care.

Figure 1.

Pharmacist Advancement of Transitions of Care to Home (PATCH) service workflow depicting steps to optimize medication safety for high-risk patients. ADE = adverse drug event; CHF = chronic heart failure; COPD = chronic obstructive pulmonary disease; CPT = current procedural technology; HIV = human immunodeficiency virus; MI = myocardial infarction; MRPs = medication-related problems; PCP = primary care physician; TOC = transitions of care.

Figure 2.

Classification of medication-related problems. *MRPs = medication-related problems. **Other = duration too long (n = 1) inappropriate timing of administration (n = 1), new indication for drug treatment (n = 1), patient forgets to use/take drug (n = 1), unnecessary drug (n = 2), inappropriate duplication of therapeutic group or active ingredient (n = 2).