Guest Perspective: Pharmacists as Integral Members of Your Care Team
Posted on December 03, 2015 |
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.
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.
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.