Quantification of admission diagnoses in an employer-based transitions of care program.

BACKGROUND: Transitions of care (TOC) are critical times for patients, and if not conducted effectively, can lead to adverse events, preventable treatment, and costly readmissions. TOC programs are implemented to improve patient care, prevent hospital readmissions, and lower financial penalties associated with readmissions. Medicare's hospital readmission reduction program (HRRP), a value-based care model, targets specific conditions and procedures. Although many TOC programs focus on HRRP conditions, there are few studies looking at prevalence of disease states seen in TOC programs embedded within an employer-based insurance program in which financial ramifications exist for all hospitalizations. There is a need to better understand the potential missed opportunities for employer-based programs solely addressing HRRP conditions. OBJECTIVE: To quantify admission diagnoses in a nontargeted employer-based TOC program. METHODS: We conducted a descriptive study of patients enrolled in a TOC program conducted by a self-insured grocery store chain. We included all patients enrolled in this TOC program who experienced a hospital admission between January 1, 2017 and August 31, 2019. Each admission diagnosis was categorized into the appropriate anatomic and physiological groups using the 2020 ICD-10-CM categories. Data were reported using descriptive statistics. RESULTS: We identified 180 eligible patients with 328 hospital admissions. The mean (± SD) age of the study population was 53.6 ± 14.4 years. The most common admission diagnoses were those in the digestive category (n = 61, 18.6% of admissions); elective total hip or knee replacement was the most prevalent HRRP condition (n = 30, 9.1% of admissions). Overall, HRRP conditions accounted for 58 (17.7%) of eligible admissions. CONCLUSION: Most of the patients seen by an employer-based TOC program were for conditions not targeted by the HRRP. By including patients beyond those covered by the HRRP, such TOC programs may realize greater improvements in financial and clinical outcomes. These benefits, however, need to be confirmed in future studies.

Impact of community pharmacist-performed post-discharge medication reviews in transitions of care.

OBJECTIVES: To describe a community pharmacist-led transitions of care process for patients discharged from the inpatient to the outpatient setting. SETTING: Independent community pharmacy chain in northwestern and central Missouri and a rural nonprofit hospital in Marshall, Missouri. PRACTICE DESCRIPTION AND INNOVATION: This innovative transitions of care service model relies on the inpatient pharmacy team for recruitment and referral of patients who use Red Cross Pharmacy. On discharge, patient information was transmitted to Red Cross Pharmacy via direct messaging in the form of a continuity of care document. Pharmacists used the patients' continuity of care documents to perform telephone-based medication reconciliations and comprehensive medication reviews. Drug-related problems and pharmacists' recommendations were documented in a subjective, objective, assessment, and plan (SOAP) note that was transmitted to the hospital and primary care provider. EVALUATION: The number and type of drug-related problems and pharmacists' recommendations were assessed with the use of descriptive statistics. Pharmacists' time spent was tracked, and its relationship to alternate variables was assessed with the use of bivariate correlations. RESULTS: Pharmacists identified 69 drug-related problems and made 145 recommendations for the 35 patients meeting study criteria. The mean time for total service completion was 65 minutes and positively correlated with a number of variables, including identification of the drug-related problem and unnecessary drug therapy and recommendation to decrease the dosage of a medication. CONCLUSION: Community pharmacists have the ability to identify drug-related problems and make recommendations for patients moving from the inpatient to an outpatient setting. In addition, the data suggest that when given adequate time, pharmacists performing service responsibilities may identify more drug-related problems, resulting in additional recommendations.

Community pharmacy transition of care services and rural hospital readmissions: A case study.

OBJECTIVES: To explore community pharmacist involvement in the transition of care (TOC) process for patients discharged with acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), or elective total hip or knee arthroplasty (THA/TKA). SETTING: Patients discharged from a 60-bed acute care hospital located in rural Missouri were seen by a community pharmacist in 2 independent community pharmacy locations. PRACTICE INNOVATION: Patients admitted with 1 of the 5 qualifying conditions and identifying the participating pharmacy as their primary pharmacy spoke with a community pharmacist within 72 hours of discharge to complete a comprehensive medication review. A follow-up telephone call occurred 7 days after the encounter to evaluate for drug-related problems, adherence, and key information recalled from the previous visit. A final telephone call occurred on the 30th day after discharge to assess for hospital readmissions and emergency department (ED) visits. EVALUATION: Number of patients readmitted or visiting the ED within 30 days after discharge. RESULTS: Of the 9 patients completing the study, none were readmitted or visited the ED within 30 days after discharge. All of the participants were satisfied with the care and education provided by pharmacists. The majority of patients recalled points related to specific medication education topics. Based on the adherence tool, 8 of the 9 study participants had at least 1 barrier to medication access or adherence that could lead to post-discharge medication-related problems. CONCLUSION: Community pharmacist involvement in the TOC process may help to prevent readmissions for patients with AMI, HF, pneumonia, COPD, and elective THA/TKA. Patients are overall satisfied with community pharmacist involvement as they move from inpatient care to home. In addition, there are multiple barriers affecting access and adherence to medication therapy while at home, providing opportunities for pharmacist intervention and assistance.

Community Pharmacist Telephonic Medication Reviews with Uncontrolled Asthma Patients: A Pilot Study.

This study reports the process of telephonic medication reviews conducted by community pharmacists for patients with asthma. The study occurred at an independent community chain in association with a Missouri Medicaid consulting group. Participants were identified utilizing claims data and met the National Quality Forum criteria for uncontrolled moderate-to-severe persistent asthma. A pharmacist performed the initial encounter via telephone which included a knowledge questionnaire, symptom control assessment, and medication review. Pharmacists identified drug-related problems (DRPs) and faxed recommendations to patients' primary care providers (PCPs). Thirty days later, pharmacists called to follow up with the patients and faxed PCPs to resolve any outstanding DRPs, new DRPs, or recommendations. Questionnaire scores and symptom control assessments were compared and analyzed utilizing a paired t-test, Chi-squared test, or Fisher's exact test. The number and categories of DRPs, recommendations made by pharmacists, and intervention time were reported. Fourteen participants completed initial encounters with twelve completing follow-up. The majority answered 'yes' to at least one symptom control assessment question indicating partially controlled to uncontrolled asthma. The average knowledge assessment score was 5.17 out of 7 initially and 5.42 for the follow-up. Pharmacists identified 43 DRPs and made 41 recommendations with a mean intervention time of 65 min.

Community Pharmacist-Provided Wellness and Monitoring Services in an Employee Wellness Program: A Four-Year Summary.

Objective: To assess the clinical outcomes of participants of an employee wellness program during four years of service implementation. Methods: A prospective cohort study was conducted at 15 independent community pharmacy chain locations in northwest and central Missouri. A total of 200 participants were enrolled in an employee wellness program, and the program included five monitoring groups-cholesterol, blood pressure, blood glucose, weight, and healthy participant groups. Participants selected a pharmacist wellness coordinator and wellness appointments were conducted, consisting of education, goal-setting, and monitoring through physical assessment and point of care testing. The primary outcome measures were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), body mass index (BMI), and waist circumference (WC). The secondary outcome measures were the proportion of patients who achieved the clinical value goals at baseline versus 48 months. The primary outcome measures among data collection time points were compared using one-way analysis of variance (ANOVA) tests, and the secondary outcomes were compared between baseline and 48 months by Chi-square or Fisher's exact tests. One-way ANOVA post hoc tests were also performed using least significant difference, to further identify which time points differed from each other. Results: At baseline, there were 134 patients in the cholesterol monitoring group, 129 in the weight monitoring group, 117 in the blood pressure monitoring group, 46 in the blood glucose monitoring group, and 26 in the healthy participant monitoring group. For patients in the blood pressure monitoring group, compared with baseline, there was a significant decrease in DBP at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood pressure goals at 48 months. For patients in the blood glucose monitoring group, compared with baseline, there was a significant decrease in FBG at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood glucose goals at 48 months. Conclusions: Pharmacist-led wellness visits provided to employee wellness patients in a community pharmacy may lead to improvements in BP and FBG values.

Physicians' Preferences for Communication of Pharmacist-Provided Medication Therapy Management in Community Pharmacy.

OBJECTIVES: (1) To identify physicians' preferences in regard to pharmacist-provided medication therapy management (MTM) communication in the community pharmacy setting; (2) to identify physicians' perceived barriers to communicating with a pharmacist regarding MTM; and (3) to determine whether Missouri physicians feel MTM is beneficial for their patients. METHODS: A cross-sectional prospective survey study of 2021 family and general practice physicians registered with MO HealthNet, Missouri's Medicaid program. RESULTS: The majority (52.8%) of physicians preferred MTM data to be communicated via fax. Most physicians who provided care to patients in long-term care (LTC) facilities (81.0%) preferred to be contacted at their practice location as opposed to the LTC facility. The greatest barriers to communication were lack of time and inefficient communication practices. Improved/enhanced communication was the most common suggestion for improvement in the MTM process. Approximately 67% of respondents reported MTM as beneficial or somewhat beneficial for their patients. CONCLUSIONS: Survey respondents saw value in the MTM services offered by pharmacists. However, pharmacists should use the identified preferences and barriers to improve their currently utilized communication practices in hopes of increasing acceptance of recommendations. Ultimately, this may assist MTM providers in working collaboratively with patients' physicians.