Factor adverse drug events (ADEs) into this trend, and the picture becomes more dire.
Enlisting pharmacists to reduce the number of ADEs in the Medicare population is just one goal in a five-point program by Novant Health to deliver healthcare value through medication management services.
"We've focused on adverse drug events because we feel they are an opportunity," explained Rebecca Bean, Novant Health's director of population health pharmacy. "Many ADEs are potentially preventable, and we know they are a contributor to hospitalizations. We believe pharmacists have a role in reducing risk for ADEs."
The list of ADE risks is extensive. By the end of Ms. Bean's February 2016 presentation on Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients, now available for replay, she had identified more than 25 different factors that can complicate medication management— everything from a patient's affordability issues, even among the insured, to fear of a drug's side effects to potential dangers from high-risk medications or health conditions.
In the Novant Health model, an RN care coordinator risk-stratifies the newly discharged, combing real-time hospital discharge notifications for red flags, such as patients taking high-risk medications or having high-risk conditions, signaling the need for a pharmacist referral.
Once referred, pharmacists conduct a comprehensive drug therapy review, keeping an eye out for adverse effects, newly prescribed medications and polypharmacy as well as general medication adherence issues.
"There could be financial barriers to getting their medications. There could be health literacy issues. Those are the sorts of things we want to make sure we're directing pharmacist resources toward," noted Ms. Bean.
Aware its providers have limited time to spend with patients, the integrated health system layers its pharmacists as an additional resource to improve quality performance, to incorporate protocols and evidence-based guidelines such as the all-important medication reconciliation. In an era of electronic health record use, the medication list has become dynamic, with many providers editing the list, Ms. Bean notes.
"We're also utilizing our pharmacy team both on the inpatient and outpatient sides to gather that best possible medication history, and then teach other clinical team members how to best reconcile medications."
Ms. Bean shared seven ways Novant Health pharmacists impact comprehensive medication management services, including the dozen benefits of incorporating these clinicians into its patient-centered medical homes (PCMH).
Encouraged by early financial gains from pharmacist interventions, particularly in the areas of medication reconciliation, therapeutic monitoring and warfarin review, Novant Health is committed to staff development to further its medication management program, exploring certification programs and even pharmacy resident programs.
"We feel it's really valuable in the discharge space to be able to get a pharmacist involved with taking care of patients," Ms. Bean concluded.
Listen to an interview with Rebecca Bean in which she offers ideas to improve the accuracy of medication lists.