Using pharmacy technicians to maximize pharmacist intervention with home health service patients.

OBJECTIVES: The objectives of this study were to assess 30- and 60-day hospitalizations and to determine the number of medication therapy problems (MTPs) identified during pharmacy technician-driven medication reconciliation for high- to very high-risk home health patients. SETTING: The study was conducted in 8 independent community pharmacy locations. PRACTICE DESCRIPTION: Realo Discount Drugs is a group of 16 independent community pharmacies serving eastern North Carolina. PRACTICE INNOVATION: Realo Discount Drugs partnered with Well Care Home Health to provide medication reconciliation services to high- and very high-risk patients. A pharmacy technician contacts the patient to obtain an accurate medication list and complete a falls risk assessment and depression screening. The technician updates the medication list, allergies, and vaccination status in the electronic health record (EHR). The pharmacist reviews the medication list for completeness; assesses for falls risk, depression, and medication interactions; and generates communication to the provider for clarifications or recommendations, if needed. Additional counseling points that need to be conveyed to the patient by the home health nurse are documented in the EHR. EVALUATION: Thirty- and 60-day hospitalizations for enrolled patients were manually pulled from documented transfers in the EHR and compared with data from a third-party administrator. MTPs were categorized by the pharmacist and documented. Descriptive statistics were used to evaluate the data collected. RESULTS: At 30 days from the start of care, 13.4% (93/695) of patients who received pharmacy services were hospitalized compared with 26.8% (143/534) of patients who did not receive pharmacy services (P < 0.01). At 60 days from the start of care, 20.9% (145/695) of patients who received pharmacy services were hospitalized compared with 33.3% (178/534) of patients who did not receive pharmacy services (P < 0.01). CONCLUSION: A technician-driven medication reconciliation process led to a reduction in hospitalizations and identified MTPs in home health patients.

Assessing care team perspectives on integration of a community pharmacist into an ambulatory care practice.

OBJECTIVES: The objective was to advance the integration of a community pharmacist within an accountable care organization (ACO) by assessing the desired roles of a pharmacist within the care team, satisfaction with the current arrangement of a pharmacist's involvement, and willingness to learn more about the roles of a community pharmacist. SETTING: A community pharmacist from Realo Discount Drugs was embedded within 3 clinics associated with Coastal Carolina Quality Care, an ACO. PRACTICE DESCRIPTION: An independent community pharmacy established a partnership with an ACO that has multiple group practices and shares an electronic health record. PRACTICE INNOVATION: Care managers referred patients to the pharmacist. The goal of community pharmacist involvement within the clinic was to provide transitions-of-care services to recently hospitalized patients, reconciling medications and dosing after discharge. EVALUATION: A 12-item online survey was conducted to evaluate the partnership. Health care team members were included; staff without expected involvement with the patient or pharmacist were excluded. Questionnaire items addressed provider type, desired role of the pharmacist, satisfaction with pharmacist involvement, and willingness to learn about or desire for more pharmacist involvement. The survey was open for 30 days with a reminder sent on day 15. Responses were thematically categorized, and content analysis was used to analyze results. RESULTS: Sixteen survey responses were received. The care team most frequently requested that the community pharmacist provide medication reconciliation (50%), medication education (44%), cost-reduction strategies (44%), and drug-interaction evaluation (38%). Care team satisfaction was positive; no respondents were unsatisfied. One-third (37%) of respondents were unaware of the pharmacist's involvement, had not referred patients to the pharmacist, or desired more interaction with the pharmacist. CONCLUSION: Survey findings were used to advance community pharmacist integration within an ACO, resulting in meaningful changes to pharmacist-provided services within clinic workflow.