Pharmacists partner with Community Pharmacy Foundation to provide better medication reconciliation for patients
Leticia (Tish) Moczygemba, PharmD, PhDassociate professor at the University of Texas College of Pharmacyknew that medication reconciliation during a transition of care was not always done or, once completed, could be inadequate.
Moczygemba was familiar with the Community Pharmacy Foundation (CPF) and thought a collaboration could be beneficial. She teamed up with a colleague Rannon Ching, PharmDhead pharmacist at Tarryville Pharmacy in Austin, Texas to confirm project details and apply for a CPF grant.
Moczygemba and Ching’s goal was to implement better medication reconciliation for patients being discharged from the hospital back to their seniors’ residence. Tarrytown Pharmacy had a 35-year relationship with a neighboring facility, a perfect opportunity for a meaningful partnership.
“It’s a common problem in community pharmacies,” Ching said. “You have a recently discharged patient and he walks up to the counter with a huge pile of discharge paperwork. They’ve been seeing their family doctor for years, and their hospital doctor has changed everything. There is a lot of confusion. »
The initial goal was to implement improved medication reconciliation and, in doing so, reduce adverse drug events and hospital readmissions.
The pharmacy used a teamwork approach, as Ching met with the assisted living team to generate interest and develop a plan. The establishment knew that it would be useful to have pharmacists within the team.
Moczygemba and Ching also knew the importance of informing and educating the residents of the facility. Pharmacists placed a flyer in each resident’s mailbox, explaining the process, so residents knew that pharmacists would be part of the care transition process.
“It was important and appreciated,” Ching said. “The residents knew we weren’t trying to sell them anything.”
A nurse at the assisted living facility informed Ching when a patient was admitted to the hospital and the expected discharge date. Pharmacists followed Medicare guidelines on how to make a billable visit.
“We had 48 hours from discharge to contact the patient and set up a meeting,” Ching said.
Due to patient education and nurse involvement, patients expected the call and were very receptive to the program. A trained pharmacy technician called the patient to complete a questionnaire to perform basic medication reconciliation, check for red flags, such as taking an opioid, diabetes or a blood thinner, which should be treated promptly, and schedule an in-person appointment. face-to-face visit with the pharmacist.
Moczygemba emphasized the importance of team involvement and efficient use of time.
“If you don’t use technicians for this, it would be impossible,” Ching said. “Our technicians are here to help you. They did a great job on the initial outreach and the 21 day follow up call.
Then Ching or his resident would come to the facility and meet with the patient for 30-60 minutes for a more in-depth counseling session.
“We were able to do a real medication reconciliation. Patients were bringing their medications and we saw a lot of discrepancies in what they were saying on the phone,” Ching said.
They also discussed why the patient went to the hospital. Ching provided the patient with an updated medication list and provided some tips to avoid readmission.
“Take houses to stay home.” For example, a patient with congestive heart failure needs to watch his weight. The pharmacy technician called patients on day 21 for follow-up.
In terms of results, pharmacists have been able to make considerable progress in helping their patients. Ching found that patients needed more information about what to expect about adverse effects from new drugs, such as orthostatic hypotension from blood pressure medications or bleeding from blood thinners.
Ching remembers a patient who told her that she was so lethargic all the time that she couldn’t enjoy life and didn’t want to live anymore.
“I had to counsel her, let her know she had just started a new blood pressure medication, and it might take some time to adjust,” Ching said.
On the follow-up call, the grateful patient told Ching that she had adjusted to the medication and was feeling fine.
“Sometimes patients just need hope and reassurance that they’re on the right track, otherwise they may just stop taking their medication and go back to where they started,” Ching said.
Although Moczygemba and Ching hit a snag with the billing model due to a leadership change at the facility, they recommend perseverance. Partnering with a physician or facility and Medicare billing, for example, could be one avenue to explore.
“It’s important to continue to push for provider status so that we can truly provide full service and be properly reimbursed,” Ching said.
In practice, what can pharmacists do with such limited time, especially in the chaos of a busy chain?
“Listen to the patient, really hear their concerns,” Ching said. “Talk to them about their concerns. Counseling isn’t a one-way street, it’s about listening to what they’re thinking.
Moczygemba and Ching suggest a call to action for pharmacists: be persistent, keep going, engage your whole team, and get out into the community to build partnerships and find opportunities. Be collaborative and creative, and be innovative to overcome obstacles.
“Don’t let a roadblock discourage you, find a new way around,” Ching said.
Tarrytown Pharmacy is also part of CPESN and Return the pharmacy. the Community Pharmacy Foundationled by Executive Director Anne Marie (Sesti) Kondic, PharmD, is a non-profit organization dedicated to advancing the practice of community pharmacy and the delivery of patient care through grantmaking and resource sharing .