Collaborative efforts between inpatient and ambulatory care pharmacists through the continuum of care in a small rural critical access hospital and clinic

Objectives:

To evaluate the collaborative efforts between inpatient and ambulatory care pharmacists as patients transition from acute to primary care.

Methods:

Patients admitted to the hospital meet with an inpatient pharmacist for medication reconciliation. The pharmacist reviews each patient’s information and identifies any actual or potential drug therapy problems (DTPs). Interventions to resolve those DTPs are then presented to the hospitalist who may or may not act upon these recommendations. The DTPs and interventions which were not successfully resolved at the hospital were relayed to an ambulatory care pharmacist who addressed them with each patient and his/her health provider at the next primary care visit. The primary endpoint includes the number of DTPs the pharmacists identified collaboratively, and the secondary endpoints include the specific types of DTPs as well as the number of DTPs successfully resolved.

Results:

A total of 20 patients were enrolled, of whom five were successfully followed up with the ambulatory care pharmacist and health care provider. There were 27 DTPs identified during the collaborative efforts. The most commonly encountered DTP was indication without drug. Upon consultation with each patient’s primary care provider, 21 of these DTPs were successfully addressed and resolved. Three out of the five patients reached their health outcomes as desired by the respective national guidelines for their disease states.

Conclusion:

This study goes beyond the current standard of pharmaceutical care and shows the role of pharmacists collaborating in different settings. This collaboration between inpatient and ambulatory care pharmacists sheds light on better health outcomes and helps bridge the gap of communication in the continuum of care process. As this study was conducted in a small rural critical care access hospital, further studies will be needed to focus on decreased readmission rates and their associated economic outcomes.