LAYERS AND LEARNERS:LEVERAGING PHARMACISTS, RESIDENTS,

TECHNICIANS, AND STUDENTS TO PROVIDE CARE TRANSITIONS SERVICES

IN A TWO-HOSPITAL HEALTH-SYSTEM

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Daniel T. Abazia, Pharm.D., BCPSClinical Assistant Professor, Ernest Mario School of PharmacyClinical Pharmacist, Capital Health Regional Medical Center

September 18, 2015

Daniel Abazia has no financial disclosures

DISCLOSURES

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By the end of this presentation, the pharmacist will be able to:

1. Explain health-system pharmacy’s role in population health.

2. Describe opportunities for pharmacist, resident, technician, and student involvement in transitions of care activities.

3. Identify potential barriers to establishing care transitions pharmacy services.

4. Advocate the use of pharmacy technicians and students in medication reconciliation and post-discharge follow-up.

LEARNING OBJECTIVES PHARMACIST

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By the end of this presentation, the pharmacy technician will be able to:

1. Explain population health and the role of health-system pharmacy.

2. Describe opportunities for pharmacy technicians in transitions of care activities.

3. Identify potential barriers to establishing pharmacy technicians in transitions of care activities.

4. Advocate the use of pharmacy technicians in medication reconciliation and post-discharge follow-up.

LEARNING OBJECTIVES PHARMACY TECHNICIAN

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LEARNING ASSESSMENT

Population health is defined as which of the following?

a. Coordination and continuity of health care during a movement from one healthcare setting to another or home.

b. A concept for organizing and delivering health care that strives for better care and incentive alignment to outcomes.

c. A care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.

d. Health outcomes of a group of individuals, including the distribution of said outcomes within the group.

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ACCOUNTABLE CARE

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www.improvingpopulationhealth.org/blog/what-is-population-health.html. Accessed September 1, 2015.www.nahq.org/education/Q-Essentials/population-health-and-care-transitions.html. Accessed September 1, 2015.National Transitions of Care Coalition. http://www.ntocc.org/Home.aspx. Accessed September 1, 2015.

Patient Safety

Medication reconciliation and timely follow-up…reduced readmissions

Transitions of Care

The health of a population requires coordination and bridging across caregivers and levels of care, appropriate engagement of other organizations and services, and

consumer engagement.

Population Health

Health outcomes of a group of individuals, including the distribution of said outcomes within the group.

NEW JERSEY: #1 IN READMISSIONS

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www.nj.com/politics/index.ssf/2015/08/nearly_every_nj_hospital_to_be_penalized_for_high.html. Accessed September 1, 2015.

PPMI recommendation D10: opportunities for technician specialization should be developed

Pharmacy technicians have been utilized for medication reconciliation in a number of settings: Emergency department Inpatient/acute care Mental health Pediatric cardiology Preoperative

Requires pharmacist training (“Best Possible Medication History”) and supervision

RX TECHNICIAN ROLE: MEDICATION HISTORIES

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Am J Health-Syst Pharm. 2011; 68:1148-52.Meyers, C. Am J Health-Syst Pharm. 2011; 68:1128-36.Chan C, et al. Can J Hosp Pharm. 2015; 68(1):8-15.

Cater SW, et al. J Emerg Med. 2015; 48(2):230-8.Brownlie K, et al. Int J Clin Pharm. 2014; 36(2):303-9.Sen S, et al. Am J Health Syst Pharm; 2014; 71(1):51-6.Van den Bemt PM, et al. Ann Pharmacother. 2009; 43(5):868-74.

LEARNING ASSESSMENT

Audience Poll – Yes or No

Do you currently utilize pharmacy technicians in the medication reconciliation process within your institution?

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Two-hospital regional health-system that serves Mercer County, NJ and Bucks County, PA

Home to a variety of regional services, including: Institute for Neurosciences

Stroke & Cerebrovascular Center of NJ (Comprehensive Stroke Center)

Level II Trauma Center

CAPITAL HEALTH

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Regional Medical Center Hopewell Medical Center

CAPITAL HEALTH CARE TRANSITIONS

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Nurse Manage

r

Pharmacist

Population Care Coordinator

Health Coach

Care Transitions

Team

LAYERS & LEARNERS

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Pharmacist/ PGY1

Resident

Student

Technician

• Review activities of tech & student

• Clinical interventions• Patient/caregiver education• Post-discharge follow-up

phone call• Best possible medication

history (BPMH)• Patient/caregiver education• Post-discharge follow-up

phone call

• BPMH/med rec clarification• Discharge medication

access• Post-discharge

appointments• Post-discharge follow-up

phone call

RX CARE TRANSITIONS EVOLUTION

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January 201

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•Care Transitions program go-live

•Focus is on Medicare patients at highest risk for readmission

September

2014

•Pharmacy Technician - Care Transitions position created

•Care Transitions becomes a longitudinal learning experience for PGY1 pharmacy residents

June201

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•Pharmacy Technician - Care Transitions position evolves into Health Coach

•Pharmacy Care Transitions team begins seeing ACO and PCMH patients on both hospital campuses

ACO = accountable care organizationPCMH = patient-centered medical home

Verify and clarify medication intake list (medication reconciliation) during inpatient admission Perform “best possible medication history” and review with

pharmacist or PGY1 pharmacy resident Verify insurance coverage to determine medication

affordability

Schedule post-discharge physician appointment(s) if patient agreeable

Document patient interview and discrepancies in electronic medical record Signed off by pharmacist or PGY1 pharmacy resident

Communication with Care Transitions Team

Conduct post-discharge follow-up phone call with pharmacist or PGY1 pharmacy resident oversight

TECHNICIAN AS HEALTH COACH

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LEARNING ASSESSMENT

Which of the following can be conducted by a pharmacist, pharmacy resident, pharmacy technician, and pharmacy student?

a. Patient/caregiver education

b. Post-discharge follow up phone call

c. Duplicate therapy clarification

d. None of the above

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BARRIERS

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Time

PharmacyResources

Development of new processes

Competing quality and

safety initiatives

Technician knowledge & interpersonal

skills

Sen S, et al. Am J Health Syst Pharm; 2014; 71(1):51-6.

Cooper JB, et al. Am J Health Syst Pharm. 2014; 71(18):1567-74.

Medication reconciliation conducted by certified pharmacy technicians (CPhTs) has been shown to be more effective than those conducted by registered nurses (RNs) RNs had significantly higher admission discrepancy

rates per medication (0.59) compared with CPhTs (0.36) and pharmacists (0.16), P < .001.1

Medication history taking/reconciliation is one of approximately 26 novel roles utilizing pharmacy technicians as per a 2008 ASHP survey.2

Demand for pharmacy department involvement in transitions of care activities can be alleviated by greater involvement of pharmacy technicians. 3

OPPORTUNITIES

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1. Kramer JS, et al. Hosp Pharm. 2014; 49(9):826-38. 2. Meyers, C. Am J Health-Syst Pharm. 2011; 68:1128-36.3. Kern KA, et al. Am J Health Syst Pharm. 2015; 71(8):648-56.

CAPITAL HEALTH CARE TRANSITIONS

HOW ARE WE DOING?Six-month pilot program (2014)

High-risk readmission patients > 1 admission in 6 months > 7 medications prior to admission One of the following diagnoses on admission: AMI,

COPD, HF, pneumoniaTotal Number of patients enrolled: 132

Out of hospital > 30-day success rate: 88.6% or only an 11.4% 30-day readmission rate The NJ benchmark 30-day readmission rate in all Medicare patients = 14.9%

LEARNING ASSESSMENT

Audience Poll

What is the largest barrier to implementing pharmacy technicians in medication history taking/medication reconciliation at your institution?

1. Time2. Pharmacy resources3. Development of new processes4. Competing quality and safety initiatives5. Technician knowledge and interpersonal skills6. Other7. None of the above 19

Takeaway #1 Involve pharmacy technicians in each step of the

development and implementation of your program

Takeaway #2 Dedicate at least one pharmacist or pharmacy

residents to your medication reconciliation technician(s) for timely follow-up of discrepancies and clinical interventions

Takeaway #3 Maintain continuous interdepartmental

communication – up to the C-suite and down to the dispensing technicians –advertise successes and gain support for additional resources

KEY TAKEAWAYS

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QUESTIONS?

dabazia@pharmacy.rutgers.eduThank you!