Reduce Adverse Drug Events Among High-Risk Patients in Your Community

Community consulting pharmacists work with patients' prescribers and pharmacies for as long as a year after hospital discharge.

A medication management intervention to avoid patient harm that has been proven effective in the hospital setting also appears effective in the community setting.

Adverse drug events occurring outside the hospital setting have been increasing, according to the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project. From 2013 to 2014, the rate of emergency department visits for adverse drug events was estimated at 4 per 1,000 people. From 2004 to 2005, the rate was estimated at 2.4 per 1,000 people.

The Pharm2Pharm medication management intervention, which has demonstrated effectiveness in the hospital setting, can reduce adverse drug events in the community setting, recent research shows.

"The Pharm2Pharm model is an effective way to address the growing problem of community-acquired medication harm among high-risk, chronically ill patients. This model demonstrates the importance of deploying specially trained pharmacists in the hospital and in the community to systematically identify and resolve drug therapy problems," the researchers wrote.

The model features a hospital consulting pharmacist role and a community consulting pharmacist role. There are three facets to the community consulting pharmacist role.

• Working with patients' prescribers and pharmacies for as long as a year after hospital discharge to enhance drug therapy regimens
   
• Focusing on medication issues to reduce hospital utilization, especially in the time period soon after hospital discharge
   
• Prioritizing medication management according to the patient's health goals and concerns

The recent research examined 189,000 hospital admissions from 2010 to 2014. The researchers found 70% of medication harm codes were community-acquired. On a quarterly basis, the Pharm2Pharm intervention reduced the rate of admissions with community-acquired medication harm by 4.28 admissions per 1,000 admissions.

"We found that the majority (70%) of medication-related harm seen among older inpatients during a 5-year period was community-acquired, suggesting the importance of targeting ambulatory and other community settings for improvement," the researchers wrote.

Boosting health and lowering costs
 

The Pharm2Pharm model generates population health benefits and lowers costs, the lead author of the research told HealthLeaders.

"It's all about better care and outcomes for patients and lower costs for payers," said Karen Pellegrin, PhD, MBA, director of continuing education and strategic planning at the University of Hawaii at Hilo's Daniel K. Inouye College of Pharmacy.

Reducing hospitalizations is a crucial element of decreasing healthcare spending, she said.

"Pharmacists are the medication experts who can work with patients across their prescribers in community settings to prevent medication-related hospitalizations. Hospital care is the biggest cost in our healthcare system, accounting for one-third of all healthcare spending in the U.S. at $1.1 trillion in 2017, according to the Centers for Medicare & Medicaid Services."

The Pharm2Pharm model has been shown to slash hospitalizations for adverse medication events, she said. "Pharm2Pharm strategically deploys pharmacists to fill a major gap in care—who's minding the medications? We achieved a 264% return on investment in our pharmacists because they reduced hospitalizations by optimizing the medication regimens for high-risk patients."

Training pharmacists
 

The Daniel K. Inouye College of Pharmacy provides training that prepares pharmacists to implement the Pharm2Pharm model.

"Best practice medication management and communicating effectively with patients and physicians are essential components of our training program, which is now available in an online, interactive, self-guided, six-hour continuing education program," Pellegrin said.

Medication management is a key element of the training, she said.

"Best practice medication management is not medication reconciliation or patient education—though these are important, and pharmacists do these well. Best practice medication management means systematically identifying and resolving drug therapy problems—first indication, effectiveness, and safety problems, and only then patient adherence problems."