Hospital Pharmacy - September 2017 - 521

Manning and Kristeller
inherently complicated as it involves multiple clinicians in
multiple settings. An additional challenge is establishing and
maintaining the necessary relationships between clinicians to
foster trust and interdisciplinary teamwork, in particular
building bridges between inpatient and community pharmacists. Community pharmacists, as readily accessible health
care providers, can provide comprehensive medication management services if they have access to relevant patient
health information. One strategy to share patient information
as they transition between hospital and community settings
is through the development of a collaborative transition of
care service where inpatient and outpatient pharmacists
establish a network where the exchange of patient information is secure and meaningful. Embracing a collaborative
practice between inpatient and community pharmacists with
the goal of improving medication management during transitions of care is not only an excellent service that patients
need but also a way of engaging all pharmacists in a comprehensive approach to patient care activities.
While the benefits to patients and to the pharmacy profession are undeniable, convincing leadership to embrace a
vision of pharmacists as providers of comprehensive medication management to patients has several challenges.
Success as holistic clinicians will depend upon a platform
where pharmacists can demonstrate that their clinical activities can generate an improvement in the quality of health
care provided and/or a cost savings. This is most powerfully
demonstrated in reducing medication-related hospital admissions and improving patient-centered health outcomes. It
will also depend upon strengthening the communication
pathways between the disciplines both within and outside of
hospitals. In addition, pharmacists may encounter resistance
from physicians and other health care providers when they
offer suggestions for improvement in medication management as these activities may be perceived as encroaching on
the clinical responsibilities of others. Overcoming this culture in health care requires diplomacy and patience while
building trust between disciplines.
In the current value-based reimbursement environment,
pharmacists need to demonstrate the value of clinical services on several levels including a reduction in health care

521
utilization, appropriate use of medications, and increased
patient engagement. It is critical that pharmacists further
explore how they will demonstrate the value of a comprehensive clinical approach. The value of these programs must be
demonstrated in either an improvement in the quality of care
or as saved dollars rather than billed dollars. The prospect of
pharmacists billing as providers of clinical care is tantalizing, but is yet unrealized in legislation. If pharmacists want
to be recognized as providers, clinicians, and expert medication consultants, they will have a higher hurdle to clear than
other professions due to this issue with reimbursement for
these services. Innovative strategies may help bridge the gap
(for instance, capitalizing on International Classification of
Diseases, 10th Edition [ICD-10] coding information to show
a reduction in medication-related problems), but ultimately
provider status would allow the most flexibility for pharmacists to assume a comprehensive clinical role.
Providing comprehensive clinical pharmacy care during
care transitions can carve out a new niche within both hospital
and community pharmacy settings and is an opportunity to
demonstrate the value of holistic and patient-centered clinical
pharmacy services. A pharmacy service that provides comprehensive medication management can also help pharmacists take a pivotal role in transitions of care, where medication
errors contribute to poor outcomes. The provision of this service can greatly benefit all of the other health care providers
who are involved in assuring the patient navigates care transitions successfully by providing the security of pharmacist
oversight regardless of the number of specialists involved in
the patient's care. Pharmacy should embrace the transition
from a focus on medication distribution to a focus on our
expertise in patient-centered medication management, and
participating in transitions of care management can be vital to
achieving this. This cultural change within the profession is
the first step needed to become the holistic health care providers we are trained to be.
Dana H. Manning
Judith L. Kristeller
Wilkes University, Wilkes-Barre,
PA, USA

Table of Contents for the Digital Edition of Hospital Pharmacy - September 2017