The Effect of a Care Transition Process to Intervention Pharmacies Versus … · 2016-03-14 · PHARMACY RESEARCH WEBINAR Pharmacists’ Role There is potential for pharmacists to

PHARMACY RESEARCH WEBINAR WWW.PHARMACISTS.CA

The Effect of a Care Transition Process to

Intervention Pharmacies Versus Usual Care on

Optimal Medication Management

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Pharmacy Research Webinar Series Hosted by:


Session SpeakerKaitlyn Krahn, BHSc, BSP, ACPR

[email protected]

mailto:[email protected]


Session Speaker

Kaitlyn Krahn is a staff pharmacist with the Regina Qu'Appelle Health Region

(RQHR). She received a Bachelor of Health Sciences degree at the University of

Western Ontario and a Bachelor of Science in Pharmacy degree from the

University of Saskatchewan. Following graduation, Kaitlyn then completed a

pharmacy residency with RQHR. During her year of residency, Kaitlyn solidified

her interest in improving patient care during discharge from hospital to home.

Her residency project focuses on the ongoing challenges and opportunities

present during transitions in care.


Outline

• Background

• Purpose/Objectives

• Methods

• Results

• Discussion

• Limitations

• Opportunities

• Acknowledgements

• Questions


Risks in Care Transitions

Transitions in care put patients at risk for drug related problems (DRPs)

• In Canadian hospitals, 8.5% of patients readmitted within 30-days 1

• 20% of patients experience an adverse event during transitions in care 2,3

• Adverse drug events most common type of AE following discharge 3

1. Canadian Institute for Health Information. CIHI. Updated 2012. Accessed September/6, 2014.2. HL, et al. Fla Nurse.2000 Mar;48(1):6.3. Forster AJ, et al. Ann Intern Med. 2003;138(3):161-167.


Pharmacists’ Role

There is potential for pharmacists to positively impact patient care

• 30 minutes with clinical pharmacist in high risk patients decreased rate of 60-day readmission by 25% (ARR 0.249) 1

• Significant reduction in 7- and 14-day post-discharge readmission rates 2

• Significant reductions in 30-day readmission rates 3

1. Bellone JM, et al. JAPhA. 2012;52(3):358-362.

2. Kilcup M, et al. JAPhA. 2013;53(1):78-84.

3. AS, et al. Am J Health Syst Pharm.2014 Sep 1;71(17):1469-79.


Purpose

To investigate the effects of a discharge transition in

care process involving a suite of interventions at the

community pharmacy (CP) level, on medication

management in high risk patients at 7- and 45-day

post-discharge as compared to normal care.


Primary Objectives

To determine the number and classification of DRPs patients experience at 7- and 45-days post-discharge

• Patient-reported

• Principal investigator-reported

• Community pharmacist-reported for intervention patients

• Classification according to Institute for Safe Medication Practices (ISMP) Canada


Secondary Objectives

• Number of patient-reported CP interventions

• Time between hospital discharge to first prescription fill, and patient-reported pick-up or delivery

• Patient-reported readmission to hospital

• Usefulness of the discharge prescription

• Patients’ loyalty to pharmacy


Inclusion and Exclusion CriteriaPATIENTS

INCLUSION EXCLUSION

• 65 years or older• Minimum of 5 prescription

medications• Discharged from hospitalist

service• Resident of Regina, SK• Diagnosed with chronic

pulmonary obstructive disease (COPD), heart failure (HF), pneumonia, atrial fibrillation (AF) or diabetes

• Lacking telephone access• Residence in a nursing

home• Documented Alzheimer’s

disease or dementia• Unable to speak English


Inclusion and Exclusion CriteriaCOMMUNITY PHARMACIES

INCLUSION EXCLUSION

• One or more pharmacist(s)with valid educator designation (diabetes or respiratory), hospital residency training, or ADAPT certification

• At least 5 patient consultations in the last three months

• Agreement to perform study interventions

• Absence of:o Prescription delivery

serviceo Compliance packaging

serviceo Access to lab viewing

software


“Suite” of Interventions

• Identification and resolution of DRPs

• Medication assessment (SMAP), or follow-up

• Medication counseling

• Laboratory monitoring

• Provision of information to patient, family physician, and/or hospital, as required

• 2 weeks adherence phone-call

• Compliance packaging, if necessary

• Facilitation in acquiring a family physician, if necessary


Outcome Assessment

• 7-, and 45-day post-discharge phone calls to the patient

• Pharmaceutical Information Program (PIP) profile review at 45-days post-discharge


Results

323• Number of patients screened

15• Number of patients meeting study eligibility

5• Patients provided consent

5• Follow-up completed


Baseline Characteristics Patient

#Age Sex

Admitting Diagnosis

Length of Stay (days)

# of Meds on

Admission

Doses Per Day on

Admission

Med Changes

Meds on Discharge

Doses /Day on

Discharge

Choice of CP

(I or R)

1 73 F AECOPD 7 21 30 5 19 33 R

2 81 M AECOPD 7 13 16 6 14 16 R

3 82 F

Post nephrecto

my hematoma

14 11 11 9 8 14 R

4 85 MUrinary

Retention3 8 7 0 8 7 R

5 83 FAcute

cholecystitis

15 17 21 9 20 32 Iˆ

Mean (SD)

81 9.2 (4.6) 14 (4.6) 17 (8.0) 6 (3.7) 14 (5.2) 20 (10.3)

AECOPD: acute exacerbation of COPD; F: female; I: intervention community pharmacy; M: male; R: regular community pharmacy; SD: standard deviation; ^: patient’s regular pharmacy was an intervention community pharmacy


Question 1:

In your experience do you find that patients remain loyal to their community pharmacy?

a) Yes

b) No

c) Not Sure


Number and Classification of Drug-Related Problems at 7-days and 45-days Post-Discharge

Patient #

DRPs Reported by:

Community Pharmacist PatientPrincipal

Investigator

17 days

N/A0 N/A

45 days 0 2

2

7 days

N/A0 N/A

45 days 0 0

3

7 days

N/A

0 N/A

45 days 0 0

4

7 days

N/A0 N/A

45 days 1 1

57 days 7 0 N/A

45 days 0 1 0


Community Pharmacist Interventions at 7-days and 45-days Post-Discharge

Patient #

Patient-Reported

Community

Pharmacist

Interventions

Patient-Reported Type of Intervention

Community

Pharmacist-

Reported

Interventions

17 days 3

Lab monitoring, Medication Education,Compliance Packaging N/A

45 days 1 Compliance Packaging

27 days 0 None

N/A45 days 0 None

37 days 0 None

N/A45 days 1 Compliance Packaging

4

7 days 0 NoneN/A

45 days 2Medication Education, Compliance

Packaging

5

7 days 1Delivery

7

45 days 3Medication Education, Compliance

Packaging, Delivery


Time to Prescription Fill, and Pick-Up or Delivery

Patient Reported

Patient #Visited Community Pharmacy?

(Y/N)

Prescriptions Filled?

(Y/N)

Picked up?

(Y/N)

Delivered?

(Y/N)

17 days Y Y N N

45 days N N N N

2

7 days N N N N

45 days Y Y Y N

3

7 days Y Y Y N

45 days N Y Y N

47 days N Y N N

45 days Y Y Y N

57 days N Y N Y

45 days N Y N Y


Question 2:

Are you surprised that many patients sent a representative to the community pharmacy on their behalf?

a) Yes

b) No

c) Not Sure


Time to Prescription Fill, and Pick-Up or Delivery

Intervention Community Pharmacist-

Reported

From Pharmaceutical Information

Profile

Patient #Time from Discharge to Pick-up or Delivery

(days)Time to Prescription Fill (days)

17 days

N/A Time to first fill: 13

45 days Time to first refill: 28

27 days

N/ATime to first fill: 1


37 days



4

7 days



57 days

0Time to first fill: 0



Our Population and DRP-PotentialMean of 14 (± 4.6) medications on admission with 6 (± 3.7) medication changes

•Farrell et al., (n=51; mean age 81 years) 1

– mean of 15 medications on admission

– 8.9 DRPs/patient

•Harris et al. (n=96; mean age 78.1 years) 2

–7 medications on admission

– 4.1 medication changes/patient1. FB, et al. Can Fam Physician.2011 Feb;57(2):168-9.

2. HC, et al. J Patient Saf.2013 Sep;9(3):150-3..


Caregivers at the Front-linesMost patients sent a delegate to the community pharmacy on their behalf

• More than 1/3 of older adults receive assistance with doctors visits or prescribed medications, or both 1

• Nine in ten caregivers in the United States identify that recipients take prescription medications and 48% of recipients require help to take medications 2

• Caregivers identify keeping prescriptions filled post-discharge a challenge 1

1. WJ, et al. J Gerontol B Psychol Sci Soc Sci.2014 Nov;69 Suppl 1:S65-72.

2. National Alliance for Caregiving. Caregiving in the U.S. 2009.


Discrepancies in perception?

Patients did not report community pharmacist involvement in recognition and resolution of DRPs at 7-days

• Braund et al., of 1,374 prescriptions 344 prescriptions required pharmacist action, and 396 individual DRPs found 1

• Eichenberger et al, pharmacy students found that 27% of 264 discharge prescriptions had DRPs 2

1. BR, et al. Int J Clin Pharm.2014 Jun;36(3):498-502..

2. EP, et al. Pharm World Sci.2010 Jun;32(3):362-72...


Limitations• Population size

• Unequal distribution in each project arm

• Assessment of fill date using PIP

– Community pharmacy integration

– Each medication reported separately

• Principal investigator assessment of DRPs


Conclusions

• Challenges with population size

• Caregivers often interact with community pharmacists

• There appear to be DRPs on discharge

• Patients are loyal to their community pharmacies


Future Opportunities

• Replication of this study on a different ward

• The role of caregivers in medication management for older adults

• The standard level of care for community pharmacists

• The role of a standard discharge prescription or summary for communication

• Exploration of factors contributing to patient-pharmacy loyalty


Question 3:Which area would you focus future research opportunities on?

a) Replication of this study on a different ward

b) The role of caregivers in medication management for older adults

c) The standard level of care for community pharmacists

d) The role of a standard discharge prescription or summary for communication

e) Exploration of factors contributing to patient-pharmacy loyalty


Acknowledgments

• Core Project Committee:

Bill Semchuk

Jennifer Bolt

Zack Dumont

• Steering Committee:

Myla Wollbaum, Pharmacy Association of Saskatchewan

Ray Joubert, Saskatchewan College of Pharmacy

Arlene Kuntz, Government of Saskatchewan

Kimberly Sentes, Towers Community Pharmacy

Ron Taylor, RQHR Hospitalist


Acknowledgments

• Ali Bell

• RQHR Hospitalists

• Intervention Group Pharmacists

• Regina Qu’Appelle Health Region


Questions?

• Please contact Kristina Allsoppat [email protected]

mailto:[email protected]


Canadian Pharmacists Conference

The Canadian Pharmacists Conference 2016 will be jointly hosted by the Canadian Pharmacists Association (CPhA) and the Alberta Pharmacists Association (RxA).

Looking forward to seeing you in Calgary, June 24–28, 2016.


Next Pharmacy Research Webinar

There will be three more pharmacy practice research webinars presented during the spring 2016.

The topic and speaker of the next webinar will be announced soon. Please check pharmacists.ca/cpprg for topics and dates.


Previously Recorded Pharmacy Research Webinars

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CO-OPP1 – Collaborative Community Offsite Pharmacy Practice Phase 1: Influenza Immunization

The Medication Assessment Centre: A New Resource for Students,Patients and Practising Pharmacists

Promoting the Development and Evaluation of Innovative Practices in Community Pharmacy: The STAT Network


Previously Recorded Pharmacy Research Webinars (continued)

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Pharmacy, Practice and Policy: Conducting and Translating OPEN Research

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Previously Recorded Pharmacy Research Webinars (continued)

Pharmacists Providing Comprehensive Medication Management

The Evolution of Pharmacists Prescribing in Scotland


THANK YOU!

To register upcoming or view previously recorded webinars go to: pharmacists.ca/cpprg

The Effect of a Care Transition Process to Intervention Pharmacies Versus … · 2016-03-14 · PHARMACY RESEARCH WEBINAR Pharmacists’ Role There is potential for pharmacists to

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