Community pharmacists’ role

in seamless care
Rik Ensing PhD PharmD
COMMUNITY

Generally community-dwelling non-

patient
&
Occasional contact with healthcare
providers
HOSPITAL ADMISSION

Derailed chronic condition, sudden event,

need for surgery

Complexity arises
SAFE TRANSITIONS?
ADMISSION HOSPITALIZATION

67%
Histories with errors
4.4
Drug changes
in Rx medication per patient

DISCHARGE AND THEN…

72% Patients with

20%
Patients readmitted
discrepancies within 30 days
A GLOBAL PROBLEM

Every transition = risk

More transitions = more risks

Chronic condition = more transitions

Aging population = more chronic conditions

More future admissions with increased complexity

SEAMLESS PHARMACEUTICAL CARE

Verify Obtain
Resolve Evaluate
Counsel Document

Seamless
care

Counsel Maintain
Transfer Document
AIM OF TODAY

READMISSION TO PRIMARY
CARE

The role of community

pharmacists post-discharge

Their challenges

Conclusion
MR. SIMONS’ ADMISSION

Rushed into ED with minor stroke

Secondary prophylaxis initiated
Hampered medication reconciliation

ED-staff relies on incomplete information

ADMISSION – Obtain bpmh

- Complete medication regimen & recent changes

OBTAIN - Intolerances & relevant lab values

- Dutch pharmacy records are reliable

CP ROLE - Make it accessible for in-hospital colleagues!

SOLUTION - A nationwide exchange system is beneficial

ADMISSION – Involve patient

- Reconciliation requires ≥ 2 sources

LITERATURE - Patient involvement is crucial

- Patients’ actual drug use vs. CP records

ELUCIDATE - Reasons behind discrepancies
- Possible DRPs

- Appropriate timing
REQUIREMENTS - Adequate communication skills
ADMISSION – Communicate

- Patients’ hospital admission

COMMUNICATE - Expected time of discharge

- 9/10 discharge prescriptions

PROBLEMS! - 30% administrative background

- Opportunity to contact the specialist

BENEFITS - Pharmacist can initiate logistic activities
- Less waste, fewer unscheduled care visits
MR. SIMONS’ READMISSION TO PRIMARY CARE

Mrs. Simons starts to worry…

Is she still the one who can support her
husband?

Who can she turn to with her questions?

READMISSION – Resume self-management

- Lack of understanding disease

CONFUSION - In the dark on who to contact

COUNSELING! - 30% patients in need for further education

- Discharge counseling is insufficient

2 STAGES • Information overload vs. urge to go home
• Discharge within 48 hours
READMISSION – Post-discharge follow-up

Tailored
communication to 150 pt
determine needs Pulmonology
and concerns Neurology
>600
DRPs

Identify
Assess
practical
patients’ 40% knowledge
adherence
knowledge
barriers 20% compliance
MR. SIMONS’ READMISSION TO PRIMARY CARE

CP initiates post-discharge verification

Prescription results in unclarities

Questions completeness, contacts

physician
READMISSION – Collaborate

- More medication problems around discharge

UNRELIABLE BPMH - Rely on possible incorrect discharge information

COLLABORATION ON DRPs

Address Communicate Resolve

Elucidate post-discharge:
during at
at admission
hospitalization discharge
≈50%
READMISSION – Utilize and anticipate

DISCHARGE COORDINATOR PATIENT-SPECIFIC CONCERNS

Outpatient pharmacy: Successful regimen management:

Address DRPs Capable to visit pharmacy?

Direct patient counseling Physically able to use devices?
Ensure complete transfer Cognitive function?
Access to in-hospital information Common DRPs prevented?
AIM OF TODAY

READMISSION TO PRIMARY
CARE

The role of community

pharmacists post-discharge

Their challenges

Conclusion
CHALLENGE – Reprioritize daily routine

Providing care vs. product supply

Comfortable with traditional tasks

Active stimulation to perform CPS

CHALLENGE – Restructure tasks

DUAL TASK
MANAGEMENT CLUSTERING

Deploy pharmacy manager: Dedicated pharmacist:

Relieve community pharmacist Healthcare increases in complexity

from operational management Guidelines evolve rapidly

Focus on Increases efficiency,

pharmaceutical care boosts quality
CHALLENGE – Finances

Health insurer Policy maker

CP reimbursed for dispensing VS Importance of pharm. care

Usual ↔ Innovative Shift to primary care
AIM OF TODAY

READMISSION TO PRIMARY
CARE

The role of community

pharmacists post-discharge

Their challenges

Conclusion
CONCLUSION

COMMUNICATE Between HCPs & with patient

COLLABORATE Within & between settings

ANTICIPATE On patients’ life & tailor follow-up

UTILIZE Define & hand-over responsibilities

TRANSFER All information you deem necessary!

CONCLUSION

COMMUNICATE

COLLABORATE

ANTICIPATE COCONUT
UTILIZE

TRANSFER
Thank you
Rik Ensing
h.t.ensing@uu.nl