This document was prepared by the 2010 ACCP Public and Professional Relations Committee: Anne L. Hume, Pharm.D., FCCP, BCPS (Chair); Jennifer Kirwin, Pharm.D., BCPS (Vice Chair); Heather L. Bieber, Pharm.D., BCPS; Rachel L. Couchenour, Pharm.D., M.B.A., BCPS; Deanne L. Hall, Pharm.D., CDE; Amy K. Kennedy, Pharm.D.; Nancy Allen LaPointe, Pharm.D.; Crystal Obering, Pharm.D., M.B.A., BCPS; Kathleen Schilli, Pharm.D.; Terry Seaton, Pharm.D., FCCP, BCPS; Jennifer Trujillo, Pharm.D., BCPS, CDE; and Barbara Wiggins, Pharm.D., BCPS, CLS, FNLA, FCCP, FAHA, AACC. Approved by the American College of Clinical Pharmacy Board of Regents on January 27, 2012.
ACCP White Papers
Improving Care Transitions: Current Practice and Future Opportunities for Pharmacists
Article first published online: 26 OCT 2012
© 2012 Pharmacotherapy Publications, Inc
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Volume 32, Issue 11, pages e326–e337, November 2012
How to Cite
American College of Clinical Pharmacy, Hume, A. L., Kirwin, J., Bieber, H. L., Couchenour, R. L., Hall, D. L., Kennedy, A. K., LaPointe, N. M. A., D.O. Burkhardt, C., Schilli, K., Seaton, T., Trujillo, J. and Wiggins, B. (2012), Improving Care Transitions: Current Practice and Future Opportunities for Pharmacists. Pharmacotherapy, 32: e326–e337. doi: 10.1002/phar.1215
- Issue published online: 1 NOV 2012
- Article first published online: 26 OCT 2012
- care transition;
- continuity of care;
- transition of care;
- medication reconciliation
During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to issues regarding care transitions and that students have several opportunities to practice the skills needed for effective care transitions. Moreover, reimbursement mechanisms that permit greater pharmacist involvement in providing medication assistance to patients going through care transitions should be explored. Although health information technology offers the potential for safer care transitions, pharmacists' use of information technology must be integrated into the national initiatives for pharmacists to be effectively involved in care transitions. This paper concludes with a discussion about the importance of recognizing and addressing health literacy issues to promote patient empowerment during and after care transitions.