Using the aftercare clinic as an interdisciplinary bridge to longitudinal care

Hospital readmission rates are increasingly used as a measure of healthcare systems’ quality and effectiveness and a tool for reimbursement or penalization if rates are excessive.1 Patients with chronic conditions and patients without a primary care provider often seek care in the emergency department (ED) setting instead of the ambulatory care setting, frequently leading to avoidable hospital admissions. Additionally, nearly 1 in 5 patients experience an adverse event during the transition from a hospital stay to home; one third of these events are preventable and another one third could have had a lower severity of effect had the patient been evaluated sooner.2 Pharmacists have long served as medication experts in assisting with the transition from inpatient care to the home setting; however, these interventions typically have a singular focus (e.g., heart failure, stroke, post-transplant status, medication reconciliation prior to first follow-up with primary care).3,–5 Unfortunately, oftentimes the intersection of multiple conditions and multiple medications (or the lack of access to medications) contributes to adverse medication-related events. The value of pharmacists as part of the primary care team has been demonstrated through improvements in disease outcomes and reduction of initial hospitalization or readmission rates.6,–8 Some facilities, as described in a publication by Cavanaugh et al.,9 have employed pharmacists to provide services during hospital follow-up appointments for patients in established primary care services, with demonstrated success in reducing 30-day hospital readmission rates. However, the Johns Hopkins After Care Clinic (JHACC) is the first service described in the literature that incorporates pharmacists into an interdisciplinary post-ED or posthospitalization safety net clinic setting and has been shown to achieve cost savings. Pharmacists are an integral component of the post-ED or posthospitalization transition in terms of selecting the most appropriate yet cost-effective medications, conducting thorough medication reconciliation, and encouraging self-management of chronic diseases.