Mary-Haston Vest, Pharm.D., M.S., BCPS; Jordan Rush, Pharm.D., M.S.; Tim Weber, R.Ph., M.B.A.;
Scott Savage, Pharm.D., M.S.; Lauren McKnight, Pharm.D., CPP, BCACP; Debbie Zachary, R.N.;
Judith Lovince, Pharm.D.; Patrick Brown, Pharm.D.
UNC Medical Center
Chapel Hill, North Carolina
Relationships between community-based pharmacies and health-system pharmacies and facilities have been sources of challenge and difficulty, as the care settings are traditionally viewed in silos and, for those health systems with outpatient pharmacies, competitors. Barriers to a more collaborative and aligned patient care model include identification of mutual patients and lack of open channels of secure communication to share information efficiently. While it is not unusual to have positive, collegial relationships between sites of care, it can be especially challenging to collaborate when patient care systems and processes are not integrated.
UNC Medical Center has partnered with select Community Pharmacy Enhanced Services Network (CPESN) pharmacies to develop a scalable model to improve transitions of care from our hospitals to the community for our shared patients. Our organization recognizes the value these pharmacies bring to the community and does not want to disrupt the care they provide but rather improve the handoff, communication, documentation, and ultimately the care of the patient in collaboration. The goal of the partnership with community pharmacies is to elevate transitions of care for patients and to identify and resolve medication-related problems that may occur post-discharge and lead to poor outcomes, such as readmissions and emergency department use.
There are several unique and innovative strategies to our department of pharmacy’s transitions of care (TOC) program with CPESN pharmacies. First, our program leverages data analytics to identify shared patients on a weekly basis. These are patients who have been admitted to our medical center and use one of our partnered community pharmacies as their primary pharmacy. Second, we have been successful in acquiring limited access to our electronic health record (EHR) for our community partners. This level of access generally allows our community partners the ability to have read-only access to health record information. It also allows for secure communication about the shared patients to be sent between the providers, clinic-based teams, and community pharmacy partners through a direct message within the EHR platform. We have also been successful in partnering with our EHR to further enhance our access capabilities to allow for community pharmacist (external to the organization) documentation to be included in the patient’s record as a note. According to our EHR vendor, we are the first organization in the U.S. with whom they worked to develop and activate such functionality allowing for community partner documentation in the health record. The TOC program has also led to documented and resolved medication therapy problems (MTP) and positive implementation outcomes through a survey of engaged stakeholders.
Our department of pharmacy has led a successful initiative to promote collaboration with local external community pharmacies. This TOC program has demonstrated the ability to promote transitions of care services, leading to identification and resolution of MTPs following discharge and improved patient outcomes. Further, this program has led to innovative advancements in EHR capabilities, promoting transparency in the documentation of pharmacy services and making this documentation visible to all team members. Lastly, the program has been positively received by the care team members, leading to a sustainable and scalable process.
