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Physician and Pharmacist collaboration can enhance patient care by increasing medication adherence, improving patient outcomes through medication management, and reducing medication errors and adverse drug reactions through collaboration on policy and protocol development. Other ways pharmacists can collaborate with physicians to make a positive impact at their facility include:
Ultimately, this collaboration will increase physician satisfaction and promote success.
Improving Medication Adherence
Patient care can be significantly enhanced by improving medication adherence. Pharmacists can assist the physicians during discharge planning by evaluating the patient’s access to an outpatient pharmacy and out-of-pocket costs, as well as providing patient medication education prior to discharge.1 As the Centers of Disease Control and Prevention (CDC) noted, “When pharmacists are part of the health care team, outcomes related to preventing or managing chronic diseases and adherence to their medications improve.”2
Medication Management
Improved medication management can be achieved with workflows that provide physicians with pharmacist input prior to prescribing in areas such as diabetes, hypertension, opioids, and antimicrobials. For example, pharmacists can assist with opioid management by assessing the patient’s prior opioid use using the state’s Prescription Drug Monitoring Program (PDMP), providing patient education, and through opioid tapering services.3 Pharmacists can manage diabetic patients through collaboration with physicians and improve their patient’s glycemic control through medical history review, monitoring baseline laboratory values, medication adherence, blood glucose monitoring, adjusting medications when needed, and providing individualized diabetes education.4
Policy & Protocol Development
Pharmacists’ involvement in policy and protocol development can promote superior patient outcomes and reduced medication errors and adverse drug reactions while improving physician satisfaction. Pharmacists are medication experts that can contribute to the development and implementation of patient care guidelines and other medication-use policies.1 Pharmacists participating in hospital committees, such as the Pharmacy and Therapeutics (P&T) Committee, have the ability to guide their institution’s use of medications based on comparative studies and cost analysis and then drive that use by making therapeutic substitutions part of hospital policy.
Identifying Opportunities for Improvement
More valuable opportunities for collaboration between physicians and pharmacists at your facility can be identified through analysis of current outcomes where pharmacists could have improved the result with additional information or a different perspective. For example, pharmacists participating in multi-disciplinary teams, such as Antimicrobial Stewardship and Anticoagulation Stewardship teams, can improve quality of patient care.1
In order to be efficient care team members, pharmacists require timely access to hospitalists for consultation and access to the patient’s chart.1 With MEDHOST Enterprise Clinicals, pharmacists can access the patient’s full chart to complete home medication reconciliations, view or place orders, view lab results, view or write clinical notes, and view medication administrations. Additionally, pharmacists have an ability to create a note to communicate consult follow-ups, document rounding notes, or provide medication change recommendations to the physician. To learn more about how MEDHOST Enterprise Clinicals can help your physician-pharmacist collaboration, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
References:
1American Society of Health-System Pharmacists. (2008). ASHP-SHM Joint Statement on Hospitalist-Pharmacist Collaboration. Retrieved from here.
2CDC. Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and Implementation Guide for Adding Pharmacists to the Care Team. Retrieved from here.
3D’Arrigo, T. (2018, May 1). Physicians share how they've collaborated best with pharmacists. Pharmacy Today. Retrieved from here.
4Ramser, K. L., Sprabery, L. R., George, C. M., Hamann, G. L., Vallejo, V. A., Dorko, C. S., & Kuhl, D. A. (2008). Physician-Pharmacist Collaboration in the Management of Patients with Diabetes Resistant to Usual Care. Diabetes Spectrum, 21, 209-214.
An estimated 82 percent of hospitals in the Hospital Readmissions Reduction Program (HRRP) received readmissions penalties1 and readmission costs were higher than initial admission costs for about two-thirds of common diagnoses in 2016.2
Generally, HRRP imposes severe financial penalties for unplanned readmission within a 30-day window. To avoid readmission penalties, healthcare facilities must focus on reducing readmission rates, improving patient outcomes, patient satisfaction, and increasing reimbursement. While readmissions are occasionally unavoidable, it is essential for facilities to focus on reducing those that are preventable.
According to a 2015 study, patients discharged from facilities serving semi-rural areas had a 32 percent greater chance of being readmitted and patients discharged from rural areas had a 42 percent greater chance of being readmitted, than those discharged from facilities in urban areas. The researchers discovered that the increase in readmission rates was driven by lower rates of post-discharge follow up care and utilization of the emergency department for primary care.3
Auerbach et al. (2016) found that approximately one quarter of readmissions are preventable by implementing discharge readiness plans, improving communication between team members, and involving the patient and caregiver in discharge planning.4 Medication reconciliation, clear discharge instructions, and patient education are key areas to consider for effective discharge planning to ensure patients can be safely transitioned to the next level of care.
Medication reconciliation ensures that patients are discharged with the correct medications, dose, time, and instructions. Your EHR should have the ability to complete medication reconciliation prior to the patient’s discharge or transition of care. Medication reconciliation can help reduce the risk of the patient experiencing an adverse drug event following discharge which is a leading preventable readmission reason.5
Ensuring that patients receive and understand the correct discharge communication and documents provides a very high return on time invested. Post-discharge follow-up appointments are critical in successfully managing the patient’s treatment outside of the hospital and reducing readmission or return visits to the emergency department. During the discharge process the patient should be provided with the dates for all follow-up appointments and digital appointment reminders should be utilized when possible.
The patient and their caregiver should have a clear understanding of the follow-up care needed, and information related to who to call and when for questions following discharge. MEDHOST provides the ability to complete discharge documents, education, and follow up instructions customized for the patient. Our solution also improves communication to primary care providers by ensuring the discharge summary is available at the time of the patients discharge. The discharge summary provides relevant information related to medication changes, pending tests or results, and follow up care that is needed.
Additionally, MEDHOST provides the ability to complete and document medication reconciliation before patient’s discharge to help reduce the risk of an adverse drug event following discharge. To increase patient engagement and improve outcomes, patients can securely access their personal health records online through YourCare Community® to review medications, instructions, lab results, receive appointment reminders, and more.
Want to learn more how MEDHOST solutions can help reduce readmission risk, contact us at inquiries@medhost.com or call 1.800.383.6278.
1 Advisory Board. (2018, September 27). Map: See the 2,599 hospitals that will face readmissions penalties this year.
2 Statistical Brief #248. Healthcare Cost and Utilization Project (HCUP). February 2019. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from here.
3 Horwitz, L. I., Wang, Y., Altaf, F. K., Wang, C., Lin, Z., Liu, S., Grady, J., Bernheim, S. M., Desai, N. R., Venkatesh, A. K., & Herrin, J. (2018). Hospital Characteristics Associated With Post discharge Hospital Readmission, Observation, and Emergency Department Utilization. Medical care, 56(4), 281–289. Retrieved from here.
4 Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K., Metlay, J. P., Fletcher, G., Ruhnke, G. W., Flanders, S. A., Kim, C., Williams, M. V., Thomas, L., Giang, V., Herzig, S. J., Patel, K., Boscardin, W. J., Robinson, E. J., & Schnipper, J. L. (2016). Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA internal medicine, 176(4), 484–493. Retrieved from here.
5 Jennifer E Prey, Fernanda Polubriaginof, Lisa V Grossman, Ruth Masterson Creber, Demetra Tsapepas, Rimma Perotte, Min Qian, Susan Restaino, Suzanne Bakken, George Hripcsak, Leigh Efird, Joseph Underwood, David K Vawdrey, Engaging hospital patients in the medication reconciliation process using tablet computers, Journal of the American Medical Informatics Association, Volume 25, Issue 11, November 2018, Pages 1460–1469, https://doi.org/10.1093/jamia/ocy115
