Retail Pharmacy: A “Community Liaison” in the Discharge Process
As hospitals and insurers seek to reduce readmissions, there is a growing opportunity for community pharmacies in the discharge process.
The transition from hospital to home is one of the most problematic in healthcare.
Consider a few statistics from clinical studies that illustrate the magnitude of the problem:1,2
- Nearly 1 in 5 older adults is readmitted to a hospital within 30 days after discharge.
- More than half of these admissions are preventable and 66% of them are related to medications.
- Older patients are discharged with an average of almost 10 different prescriptions.
- Medication information is missing from discharge summaries up to 40% of the time.
- More than 50% of the time clinically important medication errors happen after discharge.
- Fewer than 10% of discharged patients are fully compliant with their medication regimen.
Do you sense a troubling pattern?
Why these issues? Why the focus on discharge planning?
The problems related to the discharge process aren’t new. Clinical studies going back years show similar results, indicating a broken discharge process. Healthcare experts say that part of the issue has been that hospitals have operated as a silo. They have focused on the care provided while a patient was within their walls, but haven’t focused on the complete continuum of care, including a patient’s care (or the cost of that care) after a patient is discharged.
That is now changing.
Some hospitals are now being penalized for readmissions within 30 days that are deemed preventable, with the government estimating that penalties for fiscal 2013 will total $280 million.3 In addition, as hospitals become part of accountable care organizations (ACOs) and increasingly participate in bundled payment and capitated payment programs, caregivers want to care for patients in less intensive, less costly environments.
This has gotten the attention of hospital executives and has made reducing unnecessary readmissions a priority, which has put the discharge process under the spotlight.
What it could mean for community pharmacies
Historically, the discharge process has been the domain of the hospital. The Institute for Safe Medication Practices (ISMP) writes that “an abundance of literature supports the success of hospital-run programs.”4 There are examples of hospitals that have reduced readmissions rates, and reduced prescribing errors and drug-related discrepancies.
But many hospitals face challenges in extending the services they provide out into the community. In a recent survey among hospital CEOs,5 they rate “care coordination, continuum of care” as their organization’s single greatest challenge in improving their clinical quality.
The ISMP article also emphasized that effective discharge programs don’t have to be hospital-based. ISMP described how “community liaison programs” increasingly represent an opportunity for community pharmacies. More and more successes are emerging from programs that are not run by hospitals.
As an indication of how important it is for community pharmacies to focus on aligning with hospitals as part of the hospital discharge process, both CVS6 and Walgreens7 have announced initiatives in this area.
Among the key components of successful discharge and post-discharge programs are:
- Being alerted at discharge. For a discharge program to be effective, it should begin immediately at, if not before, the time of discharge. For community pharmacies, the opportunity is to develop relationships with local hospitals to become part of the discharge process. (See “Partnering with Hospitals” on SmartRetailingRx.com for more information about clinical partnerships between hospitals and community pharmacies.)
- Conducting medication reconciliation. Most patients were already taking medications before entering the hospital, and are often prescribed new and different medications at discharge. Medication reconciliation is the process of going through all of a patient’s newly prescribed medications — including their name, dosage, frequency and route — to ensure there are no safety issues and to resolve any issues.
- Providing patient education. ISMP emphasizes that “patient education about high-alert medications is at the very heart of any community liaison program.”8 (ISMP makes available free educational tools about high-alert medications.)
- Following up. The most effective discharge programs aren’t just a one-time event. They involve periodic follow-up with patients post-discharge, both over the phone and in person, to make sure that prescriptions are filled, understood and refilled. In many ways, a discharge program is similar to and can transition to an ongoing medication adherence program.
For community pharmacies, becoming part of the discharge process can mean new long-term relationships with patients, many more prescriptions to fill and refill, and a variety of new types of services to offer.
Becoming part of the discharge process and showing a meaningful improvement in drug adherence and readmissions won’t be easy. These are major problems that have existed for years.
Yet increasingly the entire healthcare system is interested in improving the discharge process and ensuring that medication reconciliation takes place. And not all hospitals or health systems have the ability to do this themselves. They need community-based partners, like community pharmacies, that have the appropriate clinical capabilities as well as trusted relationships with patients. As the world of pharmacy evolves, community pharmacies should look for opportunities to become a greater part of the discharge process.