Implementation of a Pharmacist-Led Transitions of Care Program within a Primary Care Practice: A Two-Phase Pilot Study

Erin Slazak,Merin Panthapattu,Samantha Will,Courtney Cardinal,Amy Shaver,David M Jacobs,William A Prescott,Collin M Clark

doi:10.3390/pharmacy8010004

Abstract

Pharmacists in primary care settings have unique opportunities to address the causes of ineffective care transitions. The objective of this study is to describe the implementation of a multifaceted pharmacist transitions of care (TOC) intervention integrated into a primary care practice and evaluate the effectiveness of the program. This was a two-phase pilot study describing the development, testing, and evaluation of the TOC program. In Phase 1, the TOC intervention was implemented in a general patient population, while Phase 2 focused the intervention on high-risk patients. The two pilot phases were compared to each other (Phase 1 vs. Phase 2) and to a historical control group of patients who received usual care prior to the intervention (Phase 1 and Phase 2 vs. control). The study included 138 patients in the intervention group (Phase 1: 101 and Phase 2: 37) and 118 controls. At baseline, controls had a significantly lower LACE index, shorter length of stay, and a lower number of medications at discharge, indicating less medical complexity. A total of 344 recommendations were provided over both phases, approximately 80% of which were accepted. In adjusted models, there were no significant differences in 30-day all-cause readmissions between Phase 2 and controls (aOR 0.78; 95% CI 0.21–2.89; p = 0.71) or Phase 1 (aOR 0.99; 95% CI 0.30–3.37; p = 0.99). This study successfully implemented a pharmacist-led TOC intervention within a primary care setting using a two-phase pilot design. More robust studies are needed in order to identify TOC interventions that reduce healthcare utilization in a cost-effective manner.

Highlights

Transitions of care (TOC) refers to the movement of patients between healthcare practitioners, settings, and home [1]
Most patients in the population were covered by Medicare, with nearly one-third of patients covered by commercial insurance and the remaining approximately
It is important to note that this study included only one primary care practitioner (PCP) in phase 1 and one additional PCP in phase 2, both of which are accustomed to working with pharmacists as part of the health care team

Summary

Introduction

Transitions of care (TOC) refers to the movement of patients between healthcare practitioners, settings, and home [1]. Ineffective transitions are common and can lead to adverse events, hospital readmissions, and higher healthcare costs [1]. Readmission rates are reported to be nearly 20% among. With costs of readmission estimated at $17.4 billion [2]. With the implementation of the Affordable Care Act, the Hospital Readmissions Reduction Program (HRRP) was established in. The HRRP aimed to reduce hospital readmissions for several discharge diagnosis categories in an effort to reduce healthcare costs by financially penalizing hospitals with excessive readmissions.

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