layers and learners: leveraging pharmacists, residents, technicians, and students to provide care...
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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?
[email protected] you!