Piecing together fragmented care: An evaluation of a pharmacy-driven transitions-of-care service

PURPOSE: Care fragmentation occurs when patients use multiple providers, health systems, and pharmacies, leading to polypharmacy, potentially inappropriate drug prescriptions, and increased numbers of hospital admissions and emergency department visits. Coordinating care helps improve patient outcomes and satisfaction, along with reducing healthcare costs. The purpose of this study was to evaluate the operational and clinical impact of utilizing pharmacy technicians to support a care coordination transitions-of-care (TOC) program. METHODS: This was a retrospective cross-sectional study of adult patients admitted to Henry Ford Hospital with a TOC note placed in their electronic medical record by a pharmacy technician. The primary outcome was the number and type of medication history changes made by the pharmacy technician and technician-identified medication nonadherence and access barriers. Secondary outcomes included the number of pharmacist TOC notes, discharge prescription capture, referrals and enrollment in the home delivery pharmacy, the number of ambulatory care pharmacist referrals, and the number of completed ambulatory care pharmacist encounters with associated interventions. RESULTS: A total of 2,426 patients were included in the study. Of these, 1,983 patients (81.7%) had at least one medication error on their home medication list, with 607 (30.6%) having a medication error involving a high-alert medication. Nonadherence was identified in 1,103 patients (45.6%), and barriers to medication access were identified in 308 patients (12.7%). Overall, 1,922 patients (79.2%) utilized the hospital's outpatient pharmacy at the time of discharge, with 104 patients opting to enroll in home delivery. CONCLUSION: Implementation of a pharmacy-driven TOC program identified thousands of medication errors following hospital admission and medication reconciliation with another healthcare team member. The program identified barriers to medication adherence and aimed to address them at discharge through increased prescription capture, inpatient education, and referrals to ambulatory care pharmacists.