Pharmacists Can Play Critical Roles in Transitions of Care for Older Adults
Transitions of care for older adults are areas where pharmacists can play critical roles ensuring which medications are necessary, maintaining accurate lists, and establishing good communication during handoffs, a panel of experts said during the American College of Clinical Pharmacy’s 2020 virtual annual meeting.
The majority of older adults experience multiple chronic health conditions and face an increased risk for greater health care utilization as they age, said Sarah Holmes, PhD, MSW, an assistant professor at the University of Maryland School of Nursing, in Baltimore. Polypharmacy is a major problem in this population, she said. Nearly half of those aged 65 years and older report taking more than five medications. And studies show that those discharged from hospital settings to skilled nursing facilities, on average, take around 14 medications, she said, citing data from the CDC.
“This is alarming, and because older adults are more likely to be taking more medications, they’re also at increased risk for experiencing drug-related problems and adverse events,” Holmes said. “When patients are moving from one care setting to another, often seeing multiple providers, with different documentation systems, and perhaps using different pharmacies, there are numerous opportunities for errors to occur. And there are concerns around who’s monitoring their medications to prevent these errors.”
A number of factors contribute to breakdowns in communication or costly errors during transitions of care, she said. These include unclear or ambiguous roles among providers as well as patient functional and cognitive impairment. There also can be many medication-related problems during transitions of care, added Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, a professor and the executive director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy, in Baltimore.
There may be many medication changes for older adults during hospital stays, and studies have shown that even within a hospital system, one unit may not always send the right medication list to another unit, Brandt said, let alone provide accurate lists to the patient and/or their outside provider at discharge.
“Too often than not, these changes can lead to rippling effects in terms of medications being continued that shouldn’t be, or medications being abruptly stopped that shouldn’t be,” she said. “If we’re handing off these medications to family members, often they may feel they don’t have all the complete information. … We need to be very mindful, not just of medication reconciliation but the bigger process of medication optimization, during these care transitions so we don’t impact mortality negatively, we don’t impact function, and we don’t increase the risk of coming back in the hospital.”
Pharmacists can play critical roles educating patients and caregivers, and peers, and advocating to improve access to care during transitions, Brandt said. Pharmacist interventions in these settings have been shown to result in a 42% decrease in 30-day readmission rates (Ann Pharmacother 2017;51:866-889), a 56% reduction in medication errors (J Patient Saf 2017 Jun 30. doi:10.1097/PTS.000000000000283), and cost savings that should justify pharmacists as part of teams providing and optimizing care for older adults, she said. For example, a 2018 study found a pharmacist-based transitions of care program yielded an estimated $1.8 million for a managed care plan (Am J Health Syst Pharm 2018;75:613-621).