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Currently, your authors are middle-aged, each with two young children of our own. At this stage of life, we are focused on contributing to society by doing good work, providing for and spending quality time with our families, and maintaining our personal health and wellness. As time goes by, and if we are lucky, we will someday retire, and our children will have careers and kids of their own. We will grow old, and we will transition, hopefully ever so slowly, from a place of predominantly providing care to a place of routinely receiving care. In fact, just over half of those 65 years of age and older will need some type of long term care (LTC). Sure, we can do our part, in terms of self-care and planning for the future, but things beyond our control may occur. Seemingly healthy people have heart attacks and strokes every day some more debilitating than others. Some recover fully, returning to their home life and business as usual, while others make the necessary move to some form of long term care. In either case, there are always transitions of care in terms of locations and providers. And in these transitions, there are many variables that must be considered and attended to in order to achieve the best outcomes for patients, minimize readmissions, and control costs. Given this, we would like to explore potential tools and resources that pharmacists can utilize in interventions that aim to ensure quality in transitions of care.
There are several transition-of-care interventions that pharmacists can perform that have a meaningful impact on patient outcomes and costs. These include interventions focused on medication reconciliation, patient counseling, patient-centered follow-up, healthcare provider-centered follow-up, medication adherence, and medication access. Similarly, there are different tools and resources available to support pharmacists in delivering these interventions. Let’s start with medication reconciliation, or activities that aim to assemble an accurate patient medication list. When performed properly, medication reconciliation significantly decreases adverse drug events and related costs. To ensure reliable effectiveness, it is important to develop and follow a systematic medication reconciliation process or workflow. To this end, the Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation was developed through collaboration between Northwestern University Feinberg School of Medicine and The Joint Commission, with funding from the AHRQ. The MATCH toolkit incorporates everything from assembling a team and providing education and training to designing and assessing the actual medication reconciliation process. It also includes lessons learned by various health care facilities based on their implementation of MATCH strategies.
Next we have intervention focused on patient counseling, patient-centered follow-up, and healthcare provider-centered follow-up. Patient counseling is crucial for ensuring that patients (or their caregivers) understand what medications they have been prescribed and why, and how and when to take them, as well as when to stop taking them, if appropriate, and when to seek further medical attention. Face-to-face counseling is generally considered the best approach here. However, during the COVID-19 pandemic in which we still find ourselves, this may not be preferred. In such cases, consider the expanding list of telepharmacy options. We’ve covered telepharmacy here previously, including the fact that, during the pandemic, the secretary of Health and Human Services (HHS) has loosened restrictions, allowing providers to use popular video conferencing services such as FaceTime, Zoom, and Skype. Otherwise, keep in mind that regulatory compliance must be maintained, as appropriate, with Joint Commission standards, HIPAA and other federal regulations, and state regulations, which vary by state. That said, there are several products that provide HIPAA-compliant video conferencing services, such as Skype for Business, GoToMeeting, and Zoom for Healthcare. Of course, similar tools can be used for patient-centered follow-up, or following up with the patient after hospital discharge, as well as for healthcare provider-centered follow-up, or communicating discharge plans, medication-related problems, etc., with the patient’s provider(s). In addition, text messaging may be useful for both intervention types, and there are several HIPAA-compliant text messaging applications available. These include TigerConnect, Zinc, QliqSOFT, and Spok Mobile, among others. Your pharmacy management system likely includes a text message tool, so check with your vendor to discuss options.
Lastly, medication adherence and medication access interventions are available. We’ve covered high-, low-, and no-tech approaches to medications adherence here before. We’ve also previously covered the use of social companion robots for medication adherence. Be sure to check out those previous articles for tools and technologies to boost medication adherence. As for medication access, primary barriers include costs, both direct (i.e., the cost of the medication) and indirect (e.g., having to take off work), as well as lack of transportation needed to procure the medication(s). One solution that can help with both transportation and indirect costs is medication delivery services. In addition, offering a medication delivery service has the added bonus of minimizing risks related to in-person pickup and COVID-19 transmission, for both patients and pharmacy personnel. Medication synchronization, which ensures that a patient’s multiple prescriptions are ready for pickup at the same time, can also enhance medication access and, if combined with delivery services, cut down on delivery costs. Again, check with your pharmacy management system vendor regarding its “med sync” options.
Transitions of care require extensive coordination and collaboration, and developing an effective systematic approach that is tailored to the patient is key to maximizing patient outcomes while minimizing costs. To this end, we have covered several intervention types that pharmacists can perform, as well as many tools and technologies that can be used in the delivery of these interventions. When planning your approach and choosing your tools, keep in mind that, as da Vinci said, “Simplicity is the ultimate sophistication.” We agree that technology is great (our column is called “Technology Corner,” after all), but some patients prefer low tech solutions. Determine the patient’s preference and the situational resources, and make every effort to not overcomplicate things. Given that it’s effective, keeping your approach as simple as possible will make it easier for all parties — providers, patients, and caregivers alike — to meaningfully contribute throughout the process. So, which of these interventions have you led or been a part of, and what tools did you and your team use in the process? Let us know. As always, we welcome your comments and questions.
Joshua C. Hollingsworth, Pharm.D., Ph.D., is an assistant professor, Pharmacology and Biomedical Sciences, Edward Via College of Osteopathic Medicine, Auburn Campus, Auburn University, and Brent I. Fox, Pharm.D., Ph.D., is an associate professor in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, and. The authors can be reached at firstname.lastname@example.org and email@example.com.