The Health Services Whole Person Care (WPC) Transitions of Care (TOC) Pharmacy Program supports high-risk, medically-complex Los Angeles County residents with medication-related needs as they transition from an inpatient hospital stay to their homes and communities. During this transition period, medication-related problems are common and can result in safety complications and readmissions. Pharmacist-led medication interventions have been shown to improve medication education, reduce medication errors, and even reduce readmissions. In 2020, we designed and implemented a TOC Pharmacy program with clinical pharmacists who had experience working in safety-net clinical settings and/or serving vulnerable patient populations. These 5 clinical pharmacists screened recent inpatient discharges and arranged a follow-up visit to perform interventions such as medication reconciliation and education. From May 1, 2020 through December 31, 2020, there were 5,241 inpatient discharges that met initial screening criteria, and 5,045 (96%) underwent further chart review for full inclusion criteria. There were 3,096 eligible discharges; 100% received outreach attempts, and 2,020 (65%) were successfully reached and received the TOC Pharmacy Intervention.
Examining a representative month of data, the most common TOC Pharmacy Interventions were patient counseling/education and medication reconciliation. For pharmacist-identified medication-related problems, medication underuse (poor adherence) and inadequate patient self-management of lifestyle were the most frequently cited reasons. The clinical pharmacists identified dose discrepancies between patient use and prescribed therapy as the most common safety issue, followed by polypharmacy with unnecessary medications.
This is an innovative program that has delivered a high-value pharmacy intervention to vulnerable patients during the hospital-to-home transition period when medication-related problems are common and can result in safety complications and readmissions. Despite implementing the new program at the onset of the pandemic, we were quickly able to adapt workflows to serve patients telephonically, and we provided the intervention to a large number of patients in a short timeframe. Anecdotally, we have heard numerous success stories from our patients, clinical pharmacists, WPC Community Health Workers, and clinic partners.