Abstract
Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community pharmacists provided CMRs to covered employees and dependents of a self-insured regional grocery store chain who were discharged from the hospital. Data was collected prospectively over 4 months. Discrepancies were identified among patients’ medication regimens by comparing the hospital discharge record, the pharmacy profile, and what the patient reported taking. MRPs were categorized into ten categories, as defined by the OutcomesMTM® Encounter Worksheet. Interventions were categorized using the severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were analyzed using descriptive statistics and bivariate correlations. Results: Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most common type of MRP was underuse of medication (70.6%). Significant positive correlations were found between the number of scheduled prescription medications and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r = 0.697). Most commonly, the severity levels associated with the MRPs involved the prevention of physician office visits or addition of new prescription medications (n = 10 each); however, four emergency room visits and three hospitalizations were also avoided. The total estimated cost avoidance was $92,143, or $4850 per patient. Extrapolated annual cost savings related to this service would be $276,428. Conclusions: This transitions of care service was successful in identifying and addressing MRPs and discrepancies for this patient population. By providing this service, community pharmacists were able to prevent outcomes of various severities and to avoid patient care costs.
Highlights
Medication errors resulted in an estimated 251,454 hospital deaths in 2013 [1]
Pharmacy 2019, 7, 51 prevalence, morbidity, and cost of such errors, much attention has been drawn to discrepancies and medication-related problems (MRPs) that occur during transitions of care, a time when patient care is handed off among inpatient and outpatient providers
Sixteen patients completed all aspects of the service (CMR, provision of discharge paper work, and medication reconciliation)
Summary
Medication errors resulted in an estimated 251,454 hospital deaths in 2013 [1]. Up to 80% of serious medical errors involve miscommunication among medical providers [2]. Pharmacy 2019, 7, 51 prevalence, morbidity, and cost of such errors, much attention has been drawn to discrepancies and medication-related problems (MRPs) that occur during transitions of care, a time when patient care is handed off among inpatient and outpatient providers. Previous research has shown the value of pharmacist involvement in transitions of care. Inclusion of a pharmacist has lowered rates of re-hospitalizations and emergency department visits, improved patient satisfaction with care, and increased medication adherence [3,4]. Many hospitals and pharmacy directors have recognized the importance of involving pharmacists in transitions of care activities for hospitalized patients [5]
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