If you’re a fan of industry trivia, you’ll want to remember this tidbit: Outpatient pharmacies can be found in approximately 35 percent of U.S. hospitals, according to a 2016 survey from the American Society of Health-System Pharmacists. Outpatient (ambulatory) pharmacy programs are anything but trivial, however, considering the benefits they provide patients and health systems, alike.
“Such programs require relatively minimal investment and generate rapid, positive patient outcomes and cost efficiencies for the organization,” noted the Pharmacy Network Executive Committee (PNEC) at Vizient in a 2016 report. “The committee recommends insourcing retail and specialty pharmacy services, including associated services such as bedside prescription delivery at discharge (“meds-to-beds”), discharge medication reconciliation, care-transition drug therapy management, post-discharge medication teaching and follow up, and chronic disease medication therapy and compliance management.”
Joseph Cesarz, MS, PharmD, director of ambulatory pharmacy services at UW Health in Madison, Wisconsin, said an effective bedside prescription delivery service offers more than dropping off medication. “Meds-to-beds removes a lot of barriers to medication adherence that patients may encounter if they leave without their prescriptions,” said Cesarz, who is also vice chair of the ambulatory pharmacy development (APD) committee at Vizient.
The meds-to-beds concept was developed to help decrease readmissions, improve discharge prescription capture, reduce barriers to medication adherence and improve the patient experience. Studies have shown that one-third of patients leaving the hospital will not have their prescriptions filled, and not taking medications as prescribed is one of the key reasons for readmission.
Remove barriers to reduce readmissions
Patients report that lack of convenience and high drug costs are their biggest barriers to obtaining prescription medications.
“Let’s say a patient is started on a medication before leaving the hospital. If the prescription is sent to a hometown pharmacy outside the health system, that pharmacy may not have the medication, or they may not be able to buy it from their wholesaler. If they carry the meds, they may not be open if the patient is discharged after normal business hours,” Cesarz said. “Meds-to-beds remedies these issues. We can verify benefits, so we will know if a patient has high co-pays, or if they’re uninsured or are indigent. We will then do all we can to assist them in obtaining their necessary medications before they leave the hospital.”
This attentive level of care also extends to medication counseling, which is provided by a pharmacist, physician or other clinical staff. Taking this step offers an opportunity to answer questions and address concerns.
The Washington Post recently profiled patient experiences with med-to-beds programs and quoted Bette Taylor, a kidney-transplant patient, about her experience. “It was so carefree, all I had to do was come home,” she said. “I didn’t have to go to the pharmacy as I had to do after many previous hospitalizations.” She added that a pharmacist gave her a list of the 23 new medications that were prescribed, and she was taught how to phonetically pronounce the medication names in case she had questions.
As is common with these types of programs, the pharmacist also gave Taylor a business card with contact information. Follow up after discharge is another differentiator that improves patient satisfaction and reduces readmissions.
Inpatient care teams: Outpatient pharmacy liaisons
Patient care is best supported by an outpatient pharmacy team who regularly communicates with inpatient care teams. This may include providing updates on newly available medications and related patient instructions, prescriptions that require additional time to fill or drug shortages that may impact patients whose prescriptions are filled outside of the hospital.
“The pharmacy team also needs to convey the benefits of its in-hospital location. That is, they are able to quickly fill patient prescriptions, which are linked to patients’ electronic medical records to facilitate last-minute changes,” Cesarz said. “The medications are delivered to the bedside, where questions can be answered and instructions given.”
Through this teamwork, meds-to-beds programs within hospitals facilitate prescription capture—the percentage of patients whose prescriptions are filled by the outpatient pharmacy prior to discharge.
“Prescription capture rates are a primary metric for pharmacies that are within a hospital, and meds-to-beds is the primary channel for that capture,” Cesarz said. “A key to success is having pharmacy representatives working with the inpatient teams and clinical staff who manage the e-prescribing process at discharge. The pharmacy also should track prescription capture rates from different hospital units, and offer additional information, as needed, to increase outpatient pharmacy usage.”
From the bedside up to the statistical data level, prescription capture is one of the many factors that drives an outpatient pharmacy’s financial performance. If you’re losing money on a product, can you buy it at a better price or are there other options?
“Financial performance is one of those areas where a pharmacy may have operations down cold, and they’ve figured out everything when it comes to prescription capture, but how well do they really understand the financials and explain them in a way that demonstrates value to your health system?” Cesarz said. “That’s where a pharmacy manager must be able to interpret the data in ways that are meaningful to key stakeholders.”
Every staff member in an outpatient pharmacy environment is critical to success. Technicians and pharmacists are front-line responders to meet patient needs via effective programs such as meds-to-beds and by tracking prescription capture and building relationships. Pharmacy managers’ data analysis and business acumen connect operational metrics to quality metrics.
Vizient published an Ambulatory Pharmacy Development (APD) Toolkit to support members in development of their own ambulatory pharmacies. To view the APD toolkit, click here. To read the first article in the series, click here.