Hospital Pharmacy - September 2017 - 520

724887
editorial2017

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Editorial

Pharmacy Transitions of
Care and Culture

Pharmacy, like many other health care professions, has been
adopting efforts to improve the coordination of care between
patient care settings with the goal of reducing hospital readmissions and improving health outcomes. Many medicationrelated initiatives have focused on improving individual
components of the patient care process-often limited to
improving the accuracy of the medication list. While this is
important, the majority of pharmacy-related initiatives have
stopped short of tackling the transitions of care problem
holistically with a patient-centered approach aimed at optimizing medication management and improving health outcomes. At a time when the profession is facing changes to its
traditional product-focused identity, having pharmacists provide patient-focused, holistic, comprehensive clinical services aimed at improving transitions of care may help
demonstrate a transformation in the culture of pharmacy to a
service-focused identity.
A primary focus on a holistic view of medication management stands in contrast to the traditional and ongoing emphasis on medication distribution. While medication dispensing
is still an important role, it is in a state of transition as
advances in computerized physician order entry and pharmacist-technician directed verification programs are all promising to greatly reduce the need for pharmacists in the
distribution process. This transition will lead to the reduction
in the need for pharmacists unless the value of clinical services is clearly demonstrated. One way to demonstrate value
is by taking a leadership role in preventing medicationrelated problems as patients transition through health care
settings and home. Pharmacists have a unique patient-centered perspective, allowing them to balance the needs of
multiple medical specialists prescribing medications to the
same patient. They can help patients avoid or manage adverse
effects that may impact adherence to therapy, therefore helping to ensure patients meet goals for care that maximizes
their health care outcomes. By moving toward a more holistic and patient-centered clinical approach, pharmacists can
position themselves to demonstrate an improvement in the
safe and effective use of medications during error-prone care
transitions.
While pharmacists are uniquely poised and trained to take
on the challenge of improving medication management during transitions of care, one limitation is the failure of leadership and corporations to completely support and reward a
culture of holistic patient care. For years, ever since the
introduction of the concept of pharmaceutical care by Hepler
and Strand, the pharmacy profession has identified strategies

Hospital Pharmacy
2017, Vol. 52(8) 520-521
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DOI: 10.1177/0018578717724887
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to provide clinical care to patients. Unfortunately, pharmacists often have distribution-related workload issues that
supersede clinical care-for instance, community pharmacists may have quotas for the number of prescriptions filled
during a shift. For most pharmacists, the clinical functions
they participate in are task oriented and completed where the
focus is on the medications rather than the patient. For example, adjusting dosing for patients with renal dysfunction on a
few targeted drugs but not evaluating the rest of the patient's
medication regimen for appropriate dosing or use in chronic
kidney disease. This approach, which has been promoted by
corporations and organizations who want to target some of
the most critical medication-related problems, has not delivered on the full potential of clinical pharmacy care. In addition, this approach has meant that most patients have not
been able to benefit from a comprehensive assessment of
their entire medication regimen.
A pharmacist's involvement in care transitions is an
opportunity to move beyond the task of obtaining an accurate
medication list to fully evaluate the patient's medication regimen in context of the current and prior medical history. A
comprehensive medication review should include an assessment of the efficacy and safety of all medications, interactions, appropriateness of dosing and dosage form, adherence,
and a thorough evaluation of all acute and chronic treatment
regimens with respect to optimizing patient outcomes. The
goal of transitions of care is to make sure the medical management of the patient remains cohesive throughout changes
in their care setting. It is natural that pharmacists, as the
experts in the safe and effective use of medications, assume
a leadership role in helping to assure that medication therapy
optimizes patient outcomes while keeping the patient's goals
and preferences as the focus. It is fair to say most pharmacy
initiatives tackling transitions of care do not meet this standard. This may be because there is not yet full recognition of
the value of this comprehensive pharmacist service-both in
cost savings and patient outcome improvements. Medication
management needs to be a primary component of clinical initiatives that also involve social and medical coordination.
Collaboration between hospital and community pharmacists is a way to facilitate the safe and effective use of medications during care transitions and on an ongoing longitudinal
basis, but it is easier said than done. Sharing patient information is a major barrier during transitions because different
patient care settings often do not have a natural communication channel such as a shared electronic health record. The
concept of providing continuity during transitions of care is
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