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Pharmacist-led transitions of care (TOC) services have demonstrated a positive impact on patient care and professional pharmacy organizations recommend integration of TOC-related education into doctor of pharmacy (PharmD) curricula. The objective of this study is to determine the extent to which TOC is taught in United States (US) colleges and schools of pharmacy and to characterize the educational content and the instructional methods used. An 18-question electronic survey about TOC education was sent to US school of pharmacy faculty. One survey response per school was requested. Schools with an accredited or candidate-status PharmD program were included and duplicate responses from schools were adjudicated and combined. The survey response rate was 54.6% (n = 77). Of the responding schools, 92.2% reported incorporating TOC content into their required didactic curriculum and 43.1% reported incorporating TOC content in their elective didactic curriculum. Of the 11 TOC-related topics included in the survey, 3 were covered universally in the required or elective didactic curricula of responding schools. Both lecture and active-learning pedagogies were used to teach TOC. Introductory pharmacy practice experiences and advanced pharmacy practice experiences that incorporate TOC were offered at 85.3% and 98.5% of schools, respectively. Most schools of pharmacy who responded to this survey included TOC-related content in their curricula. Research into best practices for educating students on this topic is needed to help ensure graduates are prepared to contribute to this area of practice. [ABSTRACT FROM AUTHOR]

Objective: To initiate a call to action for ambulatory care pharmacists to play a more active role in transitional care management within primary care settings by discussing relevant opportunities, experiences, and challenges.Summary: With the shift to value-based health care, greater emphasis is being placed on improving patient care quality at the lowest cost. This represents an opportunity for pharmacist integration into primary care teams to address medication management challenges in the postdischarge period. Primary care pharmacists are uniquely positioned to close gaps in care not typically addressed by hospital-based programs. These pharmacists can provide complex transition interventions tailored toward individual patients, including comprehensive medication review, patient counseling, and direct collaboration with providers. For broad acceptance of these services, current challenges include identifying and prioritizing high-risk patients, establishing the cost-effectiveness of these strategies, and ultimately applying dissemination and implementation methodologies to increase the potential impact of these interventions.Conclusion: Opportunities are expanding for primary care pharmacists to play a more substantial role in transitional care management in sustainable ways. For widespread implementation of these strategies, additional research is necessary to determine their clinical effectiveness as well as cost-effectiveness and to understand better the barriers and facilitators to adopting these interventions. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective of this study was to evaluate the impact of a transitions-of-care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmissions.Design, Setting, and Participants: A TOC program in an outpatient pharmacy, driven primarily by student pharmacists, provided telephone-based counseling to recently discharged patients. The calls were conducted within 2 to 7 days after discharge and focused on medication counseling and reconciliation, as well as promotion of a physician follow-up visit. The goal of this program was to decrease hospital readmissions among patients discharged with a cardiovascular-related diagnosis. Patient-specific information was recorded in a spreadsheet, including discharge diagnosis, and readmission diagnosis for those who returned to an inpatient facility within 30 days. This study was a retrospective chart review. Data were manually extracted from the program's data spreadsheet and the institution's electronic medical record for patients referred to the TOC program from June through November 2017. Patients discharged to hospice, prison, or a long-term care facility were excluded from analysis. Researchers collected information on patient demographics, diagnoses, and readmissions. Data analyses were performed with the use of SAS 9.4.Outcome Measures: The primary outcome measure was 30-day all-cause readmission, and the secondary measure was 30-day related readmission.Results: A total of 1219 encounters were examined. Compared with those patients without TOC participation, those who used the TOC program had a 67% decreased odds of all-cause 30-day readmission (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.22-0.48; P < 0.0001) and a 62% decreased odds of a related readmission (OR 0.38, 95% CI 0.18-0.82; P = 0.008).Conclusion: Community pharmacists and Advanced Pharmacy Practice Experience-level student pharmacists have the potential to make a significant impact on reducing hospital readmission rates. [ABSTRACT FROM AUTHOR]

Primary care pharmacists are uniquely positioned to improve care quality by intervening within care transitions in the postdischarge period. However, additional evidence is required to demonstrate that pharmacist-led interventions can reduce health care utilization in a cost-effective manner. The study's objective was to evaluate the clinical and economic effectiveness of a pharmacy-led transition of care (TOC) program within a primary care setting. This cluster randomized trial was conducted between 2019 and 2021 and included three primary care practices. Eligible patients were ≥18 years of age and at high risk of readmission. The multifaceted pharmacy intervention included medication reconciliation, comprehensive medication review, and patient and provider follow-up. The primary composite endpoint included hospital readmissions and emergency department (ED) visits within 30 days of discharge. Differences in outcomes were modeled using a generalized estimated equations approach and outcomes were assumed to be distributed as a Poisson random variable. A cost-benefit analysis was embedded within the study and estimated economic outcomes from a provider group/health system perspective. Cost measures included: net benefit, benefit to cost ratio (BCR), and return on investment (ROI). Of 300 eligible patients, 36 were in the intervention group and 264 in the control group. The intervention significantly reduced the primary composite outcome of all-cause readmissions and ED visits within 30 days (adjusted incidence rate ratio [aIRR], 0.54; 95% CI, 0.44–0.66; P < 0.001). There were significant reductions in both 30-day all-cause readmissions (aIRR, 0.64; 95% CI, 0.60–0.67; P < 0.001) and ED visits (aIRR, 0.25; 95% CI, 0.20, 0.31; P < 0.001) between groups. The net benefit of the intervention was $9,078, with a BCR of 2.11 and a ROI of 111%. Sensitivity analyses were robust to changes in economic inputs. This care transition program had positive clinical and economic benefits, providing further support for the essential role pharmacists demonstrate in providing TOC services. [ABSTRACT FROM AUTHOR]

Objective: To provide program methodology and outcomes data identifying the impact of clinical pharmacy services (CPSs) in patients with type 2 diabetes. Design: Longitudinal pre-post cohort study. Setting: Regional primary care group in Buffalo. NY, during 2006-2007. Patients: Patients with type 2 diabetes identified by their primary care providers were referred to the MedSense program; a pharmacist-led, patient-centered pharmacotherapy management program developed through university collaboration with a regional primary care physician group. Interventions: Education. clinical assessments, provider recommendations, and longitudinal follow-up of treatment goals provided by MedSense pharmacists. Main outcome measures: Clinical outcomes were followed for 1 year from the index date for primary diabetes endpoints (glycosylated hemoglobin and fasting plasma glucose) and accompanying metabolic parameters (body mass index, blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides). Economic endpoints from the payer perspective were also followed for year from the index date for medical and prescription-related costs. Results: Primary diabetes endpoints were significantly reduced versus baseline at the 6-month (-1. 1%; P < 0.0001, -39 mg/dL: P = 0.003) and 12-month (-1. 1%; P < 0.0001. -35 mg/dL; P= 0.005) assessments. Improvement rates were observed for all accompanying metabolic parameters at each assessment (range 40-64%). Geometric mean costs tended to decrease versus baseline at 6-month (-$84: P= 0.785) and 12-month (-$216; P= 0.414) assessments, despite nominal increases in diabetes and total medication costs. Conclusion: In this CPS model, there were initial and sustained reductions in the primary diabetes endpoints and a high rate of Improvement for accompanying metabolic parameters. Concurrent with clinical Improvements, total direct medical costs were reduced despite an Increase in antidiabetic medication and total medication costs. [ABSTRACT FROM AUTHOR]