Pharmacist Led Transitions of Care in an Indigent Population JEANNA SEWELL, PHARMD, BCACP CLINICAL ASSISTANT PROFESSOR AUBURN UNIVERSITY HARRISON

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1 Pharmacist Led Transitions of Care in an Indigent Population JEANNA SEWELL, PHARMD, BCACP CLINICAL ASSISTANT PROFESSOR AUBURN UNIVERSITY HARRISON SCHOOL OF PHARMACY

2 Conflicts of Interest I have no conflicts of interest or financial affiliations to disclose.

3 Objective Define the pharmacist s potential role in indigent care transitions.

4 Need in Alabama o As of 2016, 27.6 million uninsured nonelderly individuals o 1 in 10 nonelderly Alabama residents have no insurance o 47 out of 50 states (America s Health Rankings) o No access to primary care

5 Mercy Medical Clinic (MMC) Transitions Patient Flow Occurring while the patient is hospitalized Self pay patient identified by Care Coordinator Contact MMC PharmD via phone call to set up follow up appointment Care coordinator and MMC PharmD will determine an appointment time Appointment time will be shared with the patient and documented in Cerner MMC PharmD= Mercy Medical Clinic clinical pharmacist

6 24 hours prior to appointment Mercy Medical Transitions Patient Flow 7 14 days postdischarge 30 days postdischarge 60 days postdischarge Mercy will call the patient to remind them of the appointment prior to the visit Visit: Medication access problem solving, medication reconciliation, symptom assessment, f/u visit scheduling Visit with physician, NP, PA Phone call with pharmacist: medication access, symptom assessment, hospital admission status

7 Enrollment First 6 months: 126 patients referred 70 attended 55.5% Initial Visit Attendance Attended Did Not Attend

8 30 Day Readmissions 70 attended 11 of 70 had hospital admission or emergency department (ED) visit within 30 days of discharge (15.7%) 3 admission (27.3%) 8 ED only (72.7%) Admission ED Only Not Readmitted 56 did not attend 11 of 56 had a hospital admission or ED visit within 30 days of discharge (19.6%) 9 admissions (82%) 2 ED only (18%) Admission ED Only Not Readmitted

9 60 Day Readmissions 72 attended 16 had hospital admission or ED visit within 60 days of discharge (22.8%) 6 admissions (37.5%) 10 ED only (62.5%) 56 did not attend 14 had a hospital admission or ED visit within 60 days of hospital discharge (25%) 10 admissions (71.4%) 4 ED only (28.6%) Admissions ED Visits Not Readmitted Admission ED only Not Readmitted

10 Overall Readmission rates remained high in patients who were referred. Those who followed up with PharmD and MMC had lower rates of hospital encounters overall at 30 and 60 days post discharge. Those who followed up with MMC were less likely to be admitted to the hospital than those who did not follow up with MMC. 30 Days (n, %) 60 Days (n, %) Attended Readmitted Not Readmitted Readmitted Not Readmitted 11 (15.7) 59 (84.3) 16 (22.8) 54 (77.2) Admission ED Only Admission ED Only 3 (27.3) 8 (72.7) 6 (37.5) 10 (62.5) Did not attend Readmitted Not Readmitted Readmitted Not Readmitted 11 (19.6) 45 (80.4) 14 (25) 42 (75) Admission ED Only Admission ED Only 9 (81.2) 2 (18.2) 10 (71.4) 4 (28.6)

11 Future Plans NACDS funding Usual Care Initial visit at 7 14 days post discharge Follow up visit with provider 30 days post discharge Phone call from pharmacist 90 days post discharge Translational Care Usual Care + At home testing supplies (BG monitor, BP monitor, scale) Financial transportation assistance Incentive for completing the program

12 LACE Index Length of stay +1 through +6 Acuity of admission Hospital via ED=3; Other=0 Comorbidities +1 through +6 ED visits Number of ED visits within the last 6 months risk score/

13 Assessment Question Which of the following puts a patient at high risk for hospital readmission? a. Frequent emergency department visits in the previous 6 months b. Hospital admission for observation c. More than 2 chronic medications d. Lack of access to transportation

14 Assessment Question Which of the following puts a patient at high risk for hospital readmission? a. Frequent emergency department visits in the previous 6 months b. Hospital admission for observation c. More than 2 chronic medications d. Lack of access to transportation

15 Questions?

16 References 1. Key Facts about the Uninsured Population. The Henry J. Kaiser Family Foundation. November Available from: Sheet Key Facts about the Uninsured Population. 2. America s Health Rankings. United Health Foundation. December Available from: pdf. 3. Englander H, Kansagara D. Planning and designing the care transitions innovation (C TraIn) for uninsured and Medicaid patients. Journal of Hospital Medicine. 2012; 7(7): American College of Clinical Pharmacy, Hume AL, Kirwin J, Bieber HL, et al. Improving care transitions: current practice and future opportunities for pharmacists. Pharmacotherapy. 2012; 32:e326 e Phatak A, Prusi R, Ward B, et al. Impact of pharmacist involvement in the transitional care of high risk patients through medication reconciliation, medication education, and postdischarge call backs (IPITCH Study). Journal of Hospital Medicine. 2016; 11: Crotty M, Rowett D, Spurling L, et al. Does the addition of a pharmacist transition coordinator improve evidence based medication management and health outcomes in older adults moving from the hospital to a long term care facility? Results of a randomized, controlled trial. The American Journal of Geriatric Pharmacotherapy. 2004; 2(4): Hawes EM, Maxwell WD, White SF, et al. Impact of an outpatient pharmacist intervention on medication discrepancies and health care resource utilization in posthospitalization care transitions. Journal of Primacy Care & Community Health. 2014; 5(1):14 18.