Pharmacy Continuity of Care

Abstract

The concept of ‘continuity of care’ or ‘seamless care’ refers to the transition that occurs when a patient is discharged from an acute care setting to an outpatient community environment. In order to prevent errors and to ensure appropriate follow-up during this transition, communication between all healthcare disciplines is required to guarantee the implementation of an appropriate, successful treatment plan following hospital discharge. Major accrediting organizations now require the process of medication reconciliation upon hospital admission and the provision of a comprehensive list of the patient’s medications to the next healthcare provider following hospital discharge.

While the process of medication reconciliation is an important step toward improving the transfer of information from an acute care environment to the community care setting, it is limited in scope and generally only involves the primary care physician. Unfortunately, consistent infrastructures for the provision of continuity of care are lacking when a patient transitions from the acute care environment to the community care setting. The community pharmacist is often not provided with any information regarding the patient’s recent hospitalization or changes that may have been made to their medications. Comprehensive review of the patient’s medications in both the inpatient and community settings, as well as the communication that would need to occur among healthcare providers, requires a significant time commitment by pharmacists.

Medication therapy management programs, which are starting to grow within the community pharmacy setting, may assist with continuity of care by providing patients with a personal medication record that can be shared with their healthcare providers, as well as presented at admission to the hospital to assist with medication reconciliation efforts. While it is evident that identification and resolution of drug-related problems can have a significant impact on healthcare cost and patient safety, the issue of compensation for the provision of these types of services still needs to be addressed.

Upon discharge, a minimum set of information should be provided by discharging institutions to community pharmacies to ensure continuity of care. Information provided to the community pharmacy at discharge should include patient demographics, third-party prescription insurance information, new medications and associated indications, along with the name of the prescribing physician, changes to pre-admission medications (including dose changes and discontinuations), the reason for hospitalization, and follow-up plan formulated in association with the healthcare providers. Ideally, this information would be provided in a means that is easily readable, preferably electronic or printed as opposed to handwritten in order to reduce errors.

The success of continuity of care in optimizing the transition of the patient from the inpatient setting to the community setting is highly dependent on the effective cooperation and communication between all components of the healthcare system. More studies are needed to evaluate the impact of cost due to the additional resources needed to appropriately implement an effective continuity of care system.