A Review of the Barriers to Transitions of Care Between the Hospital and Community Pharmacy

Abstract

Objective: To address the barriers and implications of Transitions of Care (TOC) from the hospital to the community pharmacybased setting. Methods: A recently discharged patient presented to the community pharmacy for a Transitions of Care (TOC) service. Medication refill histories from the pharmacy and insurance company were gathered, and the patient’s discharge paperwork was requested from the hospital to identify any medication discrepancies and medication-related problems (e.g., medication non-adherence, duplicate therapy, drug-drug interactions). After obtaining this information, the pharmacist and an Advanced Pharmacy Practice Experience (APPE) student attempted to perform a medication reconciliation and identity medication-related problems to create a Personal Medication List (PML) and Medication Action Plan (MAP). Results: The community pharmacist and an APPE student were unable to effectively implement TOC in a community pharmacy-based setting due to several barriers in the healthcare system including misuse of the Health Insurance Portability and Accountability Act (HIPAA) and delayed response or nonresponse from Healthcare Providers (HCPs). As a result, the patient has been readmitted twice since the initial hospitalization. Conclusions: The patient continues to be at high risk for medication-related errors, health complications, and hospital readmissions due to unresolved medical issues and medication non-adherence. Community pharmacies should be part of the hospital’s TOC process to effectively reduce hospital readmission rates and to improve patient health outcomes.