Pharmacist case manager draws up comprehensive care plan for discharge

Plan is faxed to community MDs, PharmDs

The Iowa Continuity of Care project includes intensive case management by pharmacists, who begin medication reconciliation and education upon a patient's admission and continue with the education and medication reconciliation through discharge.

The pharmacist case manager model is being studied as part of a federal grant that will provide safety outcomes, economic outcomes, and other data about using pharmacists to support patients who have chronic illnesses and multiple medications to take upon discharge from the hospital.

"We're trying to improve drug safety and reduce adverse events among patients," says Karen Farris, PhD, RPh, a professor of pharmaceutical socioeconomics at the University of Iowa in Iowa City, IA.

One way the intervention part of the study is doing this is through having pharmacist case managers send detailed care plans to community physicians and community pharmacists.

"So many medication changes are made during hospitalizations that a family physician will get a discharge summary in a certain period of time, but a community pharmacist rarely gets anything," Farris says. "This project brings community pharmacists into the loop."

The focus is on medication reconciliation, monitoring for symptoms and outcomes, and making certain patients continue to do well and remain stable after they return home, she adds.

"When a patient is enrolled we send the informed consent documents and HIPAA release form and letter explaining the study to the community physician and pharmacist's offices," says Cindy Webber, PharmD, a pharmacy practice specialist at the University of Iowa College of Pharmacy. Webber is one of two part-time pharmacist case managers who work with the study's enrolled patients.

"We go over the patient's medications when the patient is admitted to the study," Webber says. "We catch more issues that way, as opposed to just looking at medications at discharge — but it is very time-consuming."

The pharmacist case manager also sees the patient regularly, continues education, faxes a care report to the patient's community physician and pharmacist, and makes follow-up phone calls to see how the patient is doing, she adds.

There are times when thorough communication between the hospital pharmacy case manager and the community pharmacist is crucial, Farris notes.

For example, a patient might be given a higher dose of a new drug while in the hospital to take the patient's lab values to a certain level, she explains.

"But in the community, we know the drug needs to go down to a maintenance dose," Farris adds. "So those are the important things to transmit back into the community so the physician and pharmacist know that."

Or perhaps a certain hypertension drug is used while a patient is in the hospital, but there are problems with getting the blood pressure under control, Farris says.

"So we get that under control and send the patient back with a different regimen," Farris adds. "We want to make sure everyone knows what that is."