Quality Patient Care from Hospital Bed to Home
Clinical Performance
By working with hospitals, retail pharmacies can improve outcomes and build profitable relationships
When community pharmacists work with hospitals to provide patients with medication counseling at discharge and compliance packaging, along with follow-up contact over the next few weeks, it can lead to:
- Better medication adherence
- Fewer hospital readmissions
- More customers who see the difference an independent pharmacy can deliver
In one year, Desert Hospital in Palm Springs, California, cut its 30-day readmission rate for congestive heart failure (CHF) patients by more than half, to less than 12%.1
Since each readmission costs $12,000 to $15,000, the potential for savings through improved medication adherence is substantial, noted Ram Upadhyayula, owner of Desert Hospital Outpatient Pharmacy, an independent pharmacy located within the medical center.
Hospitals also face a potential reduction of up to 3% of their Medicare payments if they have high readmission rates.2 But recent studies have shown that including pharmacists in the transition of care can reduce readmission rates.3
About three to five CHF patients a week are enrolled in the “meds to beds” program with Desert Hospital Outpatient Pharmacy, and the pharmacy retains about 65% of those customers after the first month, Upadhyayula said. The remaining 30–35% tend to be indigent, homeless, or were just visiting the area on vacation when they were hospitalized.
Coordinating Care
Before being discharged, a CHF patient at Desert Hospital receives:
- A visit from a pharmacist who explains their medications, how to take them, and why. The pharmacist also identifies any potential barriers to adherence and offers solutions.
- A 30-day supply of medications in compliance packaging. If the patient has insurance, the hospital covers any co-pay. If the patient is uninsured, the hospital pays the full cost of the medications.
- A free scale, to monitor potential fluid retention that causes weight gain.
A nurse practitioner works with the physician and pharmacist to follow up with the patient, asking about medication, weight and sodium intake. If the patient calls the pharmacy, it relays that information to the doctor or nurse.
To keep patients on track with their medications, the pharmacy enrolls them in its medication synchronization and medication therapy management program, which has nearly 500 customers. Patients in that program have an adherence rate of 90–95%.4
Eliminating Reasons for Nonadherence
When Desert Hospital Outpatient Pharmacy adopted the technology to offer strip packaging a few years ago, it showed the hospital and the local accountable care organization (ACO) how it could improve adherence. “They were pretty excited,” Upadhyayula said, recognizing the value of such a service and the benefits of sending their patients to the pharmacy.
Currently the pharmacy is adding three to four patients a day to its synchronization, compliance packaging and delivery program. Each month the pharmacy calls patients to ask about their medications and any changes, and then delivers a new supply two days before the patient would run out.
The system eliminates variables that commonly lead to nonadherence, Upadhyayula said.
- Instead of relying on the customer to call for a refill, the pharmacy calls the customer.
- Instead of relying on the customer to pick up the prescriptions, the pharmacy delivers them.
By counseling all of its patients, the pharmacy shows it is looking out for their health.
Monthly calls not just from the technician but from the pharmacist are important, he said. “Coming from the pharmacist means a lot. That creates a loyalty and a bond.”
For more ideas about how to serve local hospitals, offer bedside delivery and improve outcomes through discharge planning, read “Partnering with Hospitals” and “Retail Pharmacy: A ‘Community Liaison’ in the Discharge Process.” Learn more about working with ACOs in “What ACOs Could Mean for Your Business.”