A recent article in Innovations in Pharmacy (http://pubs.lib.umn.edu/cgi/viewcontent.cgi?article=1310&context=innovations) describes a unique pharmacy based transition of care service. Kowalski et. al. describe a transitions of care collaboration between Streu’s Pharmacy Bay Natural (an independent community pharmacy in Green Bay, WI) and Bellin Hospital. Streu’s piloted a transition of care service for the cardiac unit at Bellin.
Getting Patients Into Transitions Care
Patients in the cardiac unit were eligible for the transition service if they were a Wisconsin resident, had moderate to high risk for readmission and were anticipated to be discharged to their homes (vs. an inpatient rehabilitation or long-term care facility). The patient’s readmission risk was assessed using the LACE scoring tool. The LACE tool evaluates the potential for a patient to be readmitted post-discharge.
Note – There is a lot of good information regarding the LACE tool that can be obtained by a simple Google search. My quick search could not find a copyright on the tool, but you should do your own search to confirm.
A Streu’s pharmacist (Streu’s used their resident) met with nursing staff on the unit prior to approaching patients to confirm eligibility. Introduction of the program was not scripted and individualized for each patient. However, the introduction generally included:
- Informing patients that the service was free of charge,
- Explaining that medications did not have to be obtained at Streu’s Pharmacy, and
- A program description (what would occur during and after their appointment).
For patients who engaged with the transitions program, a one-hour appointment was scheduled. During the appointment patients:
- Had a medication review, and
- Received education on medical conditions and medications (if appropriate)
- Received a follow-up summary letter (to both patient and provider(s))
Interested patients were telephoned post-discharge to schedule an appointment. Post-discharge appointments could be scheduled at the community pharmacy or by phone. Patients who did not show up for their appointments were called to reschedule.
During the 6 month measurement period 114 patients were identified as eligible. Of the eligible patients 87 were approached to participate (included for analysis). Ultimately, 21 (24%) patients received the transitions of care service. No characteristics were found to be statistically significant between patients who received or declined the service, however, patients at a moderate risk for readmission seemed more likely to accept the pharmacist-run appointment than those at high risk (27.9% vs 15.3%; P = 0.29). Of the 66 patients who declined, 51 gave a reason (77.3%). Thirty-nine patients saw no benefit (76.5%), five patients had perceived barriers (10%), and seven patients gave reasons that fell into both categories (13.5%). The authors note that patients at higher risk believed they already had services in place to prevent readmission.