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Advancing Pharmacy Practice through an Innovative Ambulatory Care Transitions Program at an Academic Medical Center.

Jamie Cavanaugh1,2, Nicole Pinelli2, Stephen Eckel2,3

  • 1Department of Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC 27599, USA.

Pharmacy (Basel, Switzerland)
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PubMed
Summary

A pharmacist-led care transition intervention significantly reduced hospital readmissions and healthcare utilization. This program improved patient follow-up times and demonstrated substantial cost savings, highlighting the value of ambulatory care pharmacists.

Keywords:
ambulatory carecare transitionshospital follow-upmedication reconciliationpharmacistprimary care

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Area of Science:

  • Health Services Research
  • Ambulatory Care Pharmacy
  • Patient Care Transitions

Background:

  • Hospital readmissions pose a significant burden on patients and healthcare systems.
  • Preventable readmissions necessitate improved care transition strategies.

Purpose of the Study:

  • To evaluate the impact of an interdisciplinary, outpatient clinic-based care transition intervention.
  • To assess clinical, organizational, and financial outcomes of the intervention.

Main Methods:

  • A descriptive study comparing an intervention group with usual care.
  • Inclusion of pharmacists in hospital follow-up visits and outpatient clinic care.
  • Standardization of pharmacist practices across Internal Medicine Clinic (IMC) and Family Medicine Clinic (FMC).

Main Results:

  • Reduced median time to clinic follow-up by 5 days (IMC) and 4 days (any clinic).
  • Significantly lowered all-cause 30-day hospital readmission rates (9% vs. 26%).
  • Decreased 30-day healthcare utilization (readmission and ED visits) to 19% from 44%.

Conclusions:

  • The care transition intervention, particularly with pharmacist involvement, effectively reduces readmissions and healthcare utilization.
  • The program demonstrated significant cost savings, preventing 102 readmissions annually.
  • Pharmacist-led direct patient care in ambulatory settings is a valuable and replicable model for improving care transitions.