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Why The Hospital Wants The Pharmacist To Be Your Coach

Feb 19, 2013
Originally published on February 20, 2013 9:41 am

About 1 in 5 Medicare patients who leave the hospital come back within 30 days. Those return trips cost U.S. taxpayers a lot of money — more than $17 billion a year.

In October, the federal government started cracking down on hospitals, penalizing them if too many of their patients bounce back.

That has some hospitals going to the corner drugstore for help managing the care of patients like Dorothy Irene Tucker. She is a cheerful 73-year-old who's about to be discharged from Washington Adventist Hospital just outside of Washington, D.C.

She says they don't let you sleep much in the hospital. "To draw the blood, they would come in, like, twice before morning," Tucker says.

It's pretty common for patients to leave the hospital sleep-deprived. Many haven't been eating regularly, and lots of them are still coming to terms with whatever event landed them in the hospital in the first place.

It's also common for people in this bewildered state to be handed a bunch of prescriptions upon discharge. Tucker takes pride in being able to manage all the different drugs she takes. But it's a long list, and even she isn't sure exactly what she's supposed to be taking once she gets home.

"I was on a lot of medications — it was, I think, all together 23 bottles. Twenty-three bottles! So they might cut me back when I go home," she says.

Patients like Tucker could use some help keeping all those drugs coordinated, and so could the hospital. So Washington Adventist is matching her up with a local pharmacist from Walgreens, the drugstore chain.

That's a new service run by Walgreens to connect patients with pharmacists who act as coaches.

Dr. Jeffrey Kang, a vice president at Walgreens, describes the new role as "our grandfather's Walgreens on steroids." Walgreens is now contracting with hospitals to eliminate conflicting prescriptions on discharge, and then the pharmacy will check back with patients to make sure they understand all their medications and take them properly when they get home.

It's a new expense for hospitals, but it can make sense. If too many patients return to the hospital within 30 days of being discharged, Medicare cuts their payments. Health care researcher Dr. Jane Brock, of the Colorado Foundation for Medical Care in Englewood, says medication errors can be a big factor in whether a patient lands back in the hospital.

"We know that people who have medication discrepancies, or are not adhering to what the health care team thought they were adhering to, have at least double the risk of becoming a readmission," she says.

Washington Adventist Hospital's Dr. Randall Wagner says his hospital was one of the first to contract with Walgreens this way.

Wagner says he's happy with the results so far. It's harder for hospitals to monitor discharged patient medications on their own than it might sound, and a lot easier to just plug in to an experienced pharmacy.

"The infrastructure of doing these callback programs is not merely that there's a telephone and someone who can dial it," Wagner explains. "It involves creating a database, creating a group of people who can call, and if the patient doesn't answer the phone, there's someone else who can call back. There's a handoff of information between the inpatient side and the outpatient side."

Research shows that having a pharmacist follow up with recently discharged patients reduces the likelihood that they'll get worse at home and have to come back.

Dorothy Tucker returned home with three fewer medications to keep track of than when she was admitted. She says she looks forward to working with the pharmacy so she can learn her new regimen.

This story is part of a partnership between NPR, Colorado Public Radio and Kaiser Health News.

Copyright 2013 Colorado Public Radio. To see more, visit http://www.cpr.org.

Transcript

RENEE MONTAGNE, HOST:

About one in five Medicare patients who leave the hospital return within 30 days. That costs U.S. taxpayers more than $17 billion a year. Last fall the federal government started cracking down on hospitals, penalizing them if too many patients are readmitted. As Colorado Public Radio's Eric Whitney reports, in today's Business Bottom Line the corner drugstore is offering some help for hospitals.

UNIDENTIFIED WOMAN: Hi, Ms. Tucker. How are you doing today?

DOROTHY TUCKER: Just fine, thank you.

ERIC WHITNEY, BYLINE: Dorothy Irene Tucker is a 73-year-old woman who's about to be discharged from Washington Adventist Hospital, just outside of Washington, DC. She is alert and happy to be going home. In the hospital, they don't let you sleep much.

TUCKER: To draw the blood they were here like every four hours, for two days. I mean overnight they would come in like twice before morning.

WHITNEY: It's pretty common for patients to leave the hospital sleep-deprived. Many haven't been eating regularly and lots of people are still coming to terms with whatever traumatic event landed them in the hospital in the first place.

It's also common for people in this bewildered state to be handed several new prescriptions upon discharge. Dorothy Tucker takes pride in being able to manage all the different drugs she's on, but it's a big list, and even she isn't sure exactly what she's supposed to be taking once she gets home.

TUCKER: I won't know that until I get my discharge papers, 'cause I was on a lot of medications. I think it was - altogether it was 23 bottles, 23 bottles. So they might cut me back when I go home.

WHITNEY: Washington Adventist thinks patients like Tucker could use some help keeping all those drugs coordinated. The hospital itself could use some help, so they enrolled her in a new program to connect her to her neighborhood drug store.

DR. JEFFREY KANG: It's our father's Walgreen on steroids. How about that?

WHITNEY: Dr. Jeffery Kang is a vice president at Walgreens. It's now contracting with hospitals to eliminate conflicting prescriptions on discharge - and more. The pharmacy will follow up with patients to make sure they understand all their medications and take them properly when they get home. Kang says pharmacists are well-trained for this kind of primary care work, work that a lot of doctors just don't have time for.

KANG: Our pharmacists really are, I think, the greatest underutilized health care profession that we have in the country. And I think the pharmacists can fill a lot of these roles.

WHITNEY: A dozen hospitals across the country are now paying Walgreens to keep an eye on patients' medications. It's one of several partnerships like this between hospitals and pharmacies A big reason is because last fall hospitals started taking a financial hit if too many of their patients bounce back into the hospital within 30 days of being discharged. Medicare cuts their payments.

Health care researcher Dr. Jane Brock says medication errors can be a big factor in whether a patient lands back in the hospital.

DR. JANE BROCK: We know that people who have medication discrepancies, and/or are not adhering to what the health care team thought they were adhering to, have at least double the risk of becoming a readmission.

WHITNEY: Dr. Randall Wagner is the chief medical officer at Washington Adventist Hospital. It was one of the first to contract with Walgreens to track discharged patients' medications.

DR. RANDALL WAGNER: Yes, if this works, we're going to stick with it.

WHITNEY: Wagner says it's harder for hospitals to monitor discharged patient medications on their own than it might sound. It's a lot easier to just plug in to an experienced pharmacy .

WAGNER: The infrastructure of doing these call back programs is not merely that there's a telephone and someone who can dial it. It involves creating a database, creating a group of people who can call. And if the patient doesn't answer the phone, there's someone else who can call back. There's a handoff of information between the inpatient side and the outpatient side.

WHITNEY: Research shows that having a pharmacist follow up with recently discharged patients dramatically reduces the likelihood that they'll get worse at home and have to come back. And Wagner says adding the extra layer of service doesn't end up costing hospitals more, because re-admissions are expensive. And avoiding just a few more than pays for hiring pharmacists to check up on patients.

Dorothy Tucker was sent home with three fewer medications to keep track of than before. She says she looks forward to working with the pharmacy to learn her new regimen.

For NPR News, I'm Eric Whitney in Denver.

MONTAGNE: This story is part of a collaboration of NPR, Colorado Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.