Health-System Pharmacy Evolution: An Expanded Role for Med Reconciliation

Practice settings across healthcare are finding value in expanding the pharmacy’s role, and health systems are no exception. In this interview with Carolinas HealthCare System Director of Outpatient Pharmacy Services Frank McCree, we hear an accelerating shift toward allocating pharmacy resources where they can best impact health-system performance.

ComputerTalk: Frank, how have you been seeing health-system pharmacy services evolve?

Frank McCree: A lot of health systems are realizing that they have an opportunity to move to where the pharmacy is playing a much more prominent role in providing care. The environment has changed to where there are payers, both private and of course government payers, that want to pay health systems to keep patients healthy, and to keep them out of the hospital. The shift is away from how many beds you have filled and, instead, toward performance in keeping people well. Pharmacy is definitely right in the middle of making this happen, because the number-one intervention that’s used in order to treat most medical conditions is pharmaceuticals.

CT: What’s been the practical impact of all this on how health systems are allocating resources?

McCree: Here at Carolinas HealthCare, as I imagine in all hospitals, we have put a lot of money into our infrastructure for supporting services for managing the patient population. This shift is really accelerating, and we in pharmacy are being given responsibility for a population. It’s what we’ve been hearing so much about with the pharmacy home and neighborhood model.

One of the most significant changes, I think, is actually taking place when patients are coming into the health system. We’re placing a greater emphasis on the work being done to reconcile medications and to make sure that everyone involved with the care of that patient knows what the medication profile is. This is where we can make the best start for ensuring that we’re not layering drugs on top of one another inappropriately. Everyone needs to be on the same page at the very start of each interaction we have with a patient, and this is particularly true of a patient’s medication profile.

CT: What’s pharmacy’s ongoing role in patient care, then?

McCree: We’re supporting the medication decision-making throughout the patient’s time in the health system, of course. But the pharmacy resources we’re allocating really pay off when the patient is discharged or leaves the clinic setting, and we’re there to make sure that the med profile is complete and up to date, taking into account whatever medications the patient was on to begin with, whatever may have changed while they were in our care, and whatever may be new. It’s our goal to make sure that we’re doing a great job of sending the patient back out into the community with a rational and appropriate medication regimen and an accurate list of what they’re taking so that everyone from the patient to their caregiver to their pharmacy to their doctor is on the same page, just as everyone within the health system was when we did the med reconciliation at intake.

CT: We’ve been talking about allocating pharmacy resources. What’s this mean in practice?

McCree: I see our hospital now ensuring that we have the proper pharmacist and pharmacy technician resources at the exit door, so to speak, just like we have them at the front door. We are positioning the pharmacist as the resource to help both prescribers and patients with understanding the medications they are taking and also to be a resource that the patient can follow back up with if they got home and find they’re confused. This is central to preventing negative medication-related outcomes. CT