Recently we’ve seen growing interest in the role of the pharmacy department in managing population health. And really, this shouldn’t come as any surprise.
Non-adherence to medications post-discharge is one of the largest drivers of patient readmissions. In fact, more post-discharge adverse events are related to drugs than to any other causes. To avoid readmission penalties, organizations are now incented not only to better manage patients’ medication regimens in acute settings but also to ensure that patients fill their prescriptions and correctly adhere to their drug regimens post-discharge.
I sat down with Chief Pharmacy Officer Todd Karpinski PharmD, MS, and Director of Pharmacy Philip Brummond PharmD, MS, at Froedtert & the Medical College of Wisconsin Froedtert Hospital to discuss how they’re reinventing the role of the pharmacy department. Froedtert Hospital is a 500-bed academic medical center and the primary teaching affiliate of the Medical College of Wisconsin.
Carve out a role for pharmacists on the inpatient care team
Patients often need a complete medication history upon admission to a hospital, and they need further medication reconciliation upon discharge to identify potential medication errors.
Though these responsibilities frequently fall to the nursing department, Froedtert ran a pilot project in 2007 showing that medication lists were more accurate when a pharmacist was in charge of these responsibilities. Froedtert has been profiled as a best practice organization for its pharmacist-led medication management strategies.
“Now, somewhere between 95-98% of our patients meet with a pharmacist when they are admitted to the hospital, and almost every single patient receives pharmacist-led medication reconciliation upon discharge.”
—Todd Karpinski, PharmD, MS, Chief Pharmacy Officer
Deploy pharmacists to close care plan gaps
There are many reasons patients don’t fill their prescriptions post-discharge: they don’t want to wait in line at a retail pharmacy, they’re worried about medication costs, or maybe they simply lack transportation.
To combat these barriers, Froedtert instituted a bedside medication delivery program, ensuring that patients have their medications upon discharge and giving pharmacists the opportunity to educate patients about their drug regimens when delivering new medications.
Beyond improving post-discharge medication adherence, the program also enhances the patient experience and adds additional revenue, as Froedtert fills the medications in their own on-campus retail pharmacies. Dr. Karpinski noted that this revenue balances out the labor costs associated with executing the program.
And pharmacy’s involvement doesn’t end there. A pharmacist follows up with high-risk patients post-discharge to see if they’re having any adverse events and to ensure they are complying with their medication regimens.
Align pharmacy department goals with institutional goals
All of these initiatives are driven by broader institutional goals to coordinate care and reduce unnecessary readmissions. Though every organization will be different, linking pharmacy into the overall population health strategy can have a significant impact.
“How we are paid as a health system is changing. As a result, pharmacy cannot be a silo—the pharmacy enterprise must be linked into the strategy of the entire organization. This is especially true around transitions of care, where health care has traditionally struggled…I think the biggest change in the last three years is the interconnectivity between pharmacy and many, many other departments in the hospital.”
—Philip Brummond PharmD, MS, Director of Pharmacy