The PRAXIS Nexus The PRAXIS Nexus

Guest Perspective: Pharmacists as Integral Members of Your Care Team

Posted on December 03, 2015   |   
6 Comments   |   
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This PRAXIS Nexus guest post was written by two PRAXIS Advisory Board members and pharmacists Dr. Danny Fu and Dr. Andy Woods. Dr. Fu is currently an ambulatory care clinical pharmacist supervisor at Carolinas HealthCare System NorthEast in Concord, NC. Dr. Woods is Associate Professor of Pharmacy at the Wingate University School of Pharmacy and an Internal Medicine Clinical Pharmacy Specialist at Carolinas Medical Center – Main, an 874-bed teaching hospital in Charlotte, North Carolina.

In the wake of significant changes to how health care dollars are being redistributed and reimbursed, there has been an increased focus for healthcare systems to decrease the number of avoidable hospital readmissions for many chronic diseases. COPD has garnered considerable attention due to the relatively high rates of readmission reported by many health care systems. In efforts to reduce unplanned hospital utilization (emergency department visits and early readmissions), multidisciplinary task forces have been assembled and charged with improving the quality of patient care. Pharmacists are rightfully finding themselves to be integral members of these multidisciplinary task forces secondary to their unequivocal pharmacotherapy knowledge and their awareness of and solutions for barriers to medication adherence.

Dr. Danny Fu

Pharmacists are uniquely positioned to improve the quality of care a patient with COPD receives. As part of a multi-disciplinary team providing direct care to a patient with COPD, pharmacists serve as medication/pharmacotherapy experts, tailoring each patient’s medication regimen to his or her specific needs (e.g. selecting inhaler devices suitable for a patient’s noted/observed dexterity). In selecting a patient specific pharmacotherapy plan, considerable attention is paid to efficacy and the likelihood of compliance. The chronic treatment of COPD relies heavily on the use of multi-dose inhalers. Proper use of multi-dose inhalers stabilizes and possibly improves lung function thereby reducing hospitalizations. However, many patients are nonadherent with inhaled medications due to cost while countless others do not reap maximum benefit secondary to poor technique.

Dr. Andy Woords

A pharmacists’ knowledge of and access to medications coupled with their aptitude for teaching proper inhaler technique are intrinsic to the task of improving patient medication nonadherence. In addition to aiding in the selection of affordable medications, pharmacy-driven programs utilizing multi-dose medication dispensing on discharge (MMDD) have been shown to decrease early hospital readmission (both 30 and 60-day readmission) following an acute exacerbation of COPD. MMDD is a process in which patients are given an appropriately labeled inhaled medication at hospital discharge pursuant to a provider’s order to continue the medication upon discharge. The employment of pharmacists as patient educators and pharmacist-led discharge medication reconciliation have both been linked to reduced readmission rates. New data suggests that a pharmacist’s tracking of outpatient adherence through post-discharge outreach phone calls results in a decrease in emergency department visits and early hospital readmissions.

With hospital reimbursement rates being tied to both the overall inpatient care and all-cause readmissions for patients post COPD exacerbation, data indicates that the majority of readmissions are secondary to comorbid conditions (e.g. heart failure). By being involved in the selection of appropriate pharmacotherapy, discharge counseling, and post-discharge follow-up, pharmacists can improve patient outcomes by reducing unplanned readmissions for not only COPD, but also other chronic medical conditions.

6 Comments



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  • Thank you for your post, Drs. Fu and Woods! I wanted to share another interesting article, this one on pharmacist home visits as a tool in combating heart failure readmissions: http://drugtopics.modernmedicine.com/drug-topics/news/readmissions-fall-after-pharmacist-home-visits. In this pilot project, pharmacists conducted 60- to 90-minute monthly home visits with patients for three months after discharge; the hospital's resulting readmissions rate was dramatically lower than the national average (the article did not identify their pre-intervention readmission rate).

    Reply
    • Kristen - this is awesome!!! The Better Breather Club to which I belong has 1 or 2 pharmacists present at each of our monthly meetings - they are available to answer general questions, and also to meet one-on-one with individual BBC members after the regular meeting. I am sure that this has helped quite a few of our members. After hospitalization, having in-home visits would really be great!!!
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    • I think so too, Karen -- I had not read before about pharmacists doing in-home visits. Hope to see more promising results from this kind of work! Will post anything I come across.
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  • Great input, I think the pharmacist is key to the multi-disciplinary approach in preventing readmissions. On many occasion I have used their skill sets to teach medications and their interactions, and what side effects to look for. I have even asked their help in screening meds that might be duplicate or unnecessary, so that we can ensure the med list is up to date and allows the patient a reasonable number of critical meds to manage and keeping in mind the cost.
    Both Danny and Andy have critical partners in the readmission work and are valuable resources to our community. Thank you both for your continued interest and support.

    We would love to hear how you are using this valuable resource in your facility.
    Reply
    • I agree that pharmacists CAN be key team members but unfortunately they are NOT all equally up to date on respiratory health and treatments. It is good to ask them any questions you have about your mess and verify the info by reading the handouts which come with your medications. In a less chaotic world, they would be able to keep up with the many different inhalers, spacers, nebulizers and more. As a practical matter, they do their best and we must do ours.
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    • Like HIcopd i think they could be but in my case they aren't. One of the issues is the high cost of the drugs we take and if on a medicare Part D program your primary pharmacy may change year to year as plans change so one never quite forms a relationship with a single pharmacist, then you have the issue of the donut hole which forces many of us to places like ADC so now my Pharmacist is in a foreign country.
      While I think pharmacists can or could be a valuable resource, this article sounds more like an advertisement than anything else. IMHO.

      Reply

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