This paper was in my pile of reading I am finally catching up from in the Journal of the American Pharmacists Association, published in October 2016, titled the "Experience with technology-supported transitions of care to improve medication use," by Frail and colleagues. Based on a recent surge of interest in using different ways to dispense medications to patients and the use of telemedicine services, I thought it would still be interesting to talk about.
This pilot study focused on using pharmacists services in a rural health setting in the states of Ohio and Indiana with one 92-bed general/surgical county hospital and one independent pharmacy company with 5 locations. Essentially, the investigators wanted to pilot a program whereby pharmacists would provide services to patients post-discharge and create a personalized medication regimen based on collaboration with the patient's provider.
Three pharmacists were involved in the pilot study, and focused on three services offered by the pharmacy:
- Drug-Delivery service conducted by drivers hired by the pharmacy to deliver medications to the patient.
- Telemedicine Services provided by an internet/LTE connected tablet that the drivers would set up when visiting the patient at their home on delivery whereby the pharmacist and patient could communicate with each other.
- Medication Reconciliation was conducted whereupon the pharmacist then created a finalized medication regimen for the patient to be on based on available records and after communicating with the patient. The regimen was then used to package in a clear plastic packet (by day and time) for the patient to receive by delivery within 72hrs.
The pharmacist would then follow up with the patient in 30-days, and more frequently as required based on more urgent situations.
Self-reported admissions were collected by the patients involved at 30 and 180 days. In addition, other surveys were utilized to collect patient satisfaction with the program. The study was conducted between May 2014 to May 2015, and 18 patients participated in the pilot study. Demographics of the patients were mostly elderly (81 years average age), and mostly female (n=12). Of those that participated, 3 were readmitted at 30 days, and 2 at 180 days. Patients were overall relatively satisfied with the program.
The authors highlighted several areas worth mentioning:
- The importance of partnerships and buy-in - While the investigators had many people in senior leadership in the hospital onboard, there seemed to a barrier with providers and staff making recommendations on the service. The authors theorized this could be due to thoughts that this was an overall marketing scheme.
- Medication reconciliation was a difficult process with multiple players and using the pharmacy as a central source to conduct the profess. Removal of previous medications from the patients home and having a virtual communication process undoubtedly helped.
- Home delivery around packaging the regimen decided upon after the initial visit was a process that is timely, and could pose a logistical barrier for others that may try to emulate this pilot program.
Overall, this was an interesting pilot, namely because I have heard of such service, just never saw the data with longitudinal follow-up of outcomes (ie. hosptializations). The next step needless to say is whether such interventions decrease med rec problems or possibly decrease hospitlazations. Since the criteria didn't necessarily exclude any populations, a follow-up analysis should probably center on a high risk group with a comparator arm. I would say this pilot study definately hit some key issues that anyone looking to emulate should keep in mind, such as buy-in and logistical barriers.
Frail CK, Garza OW, Haas AL. Experience with technology-supported transitions of care to improve medication use. J Am Pharm Assoc (2003). 2016;56(5):568-72.