Development of a Pharmacy Resident-Run Transitions of Care Service in a High-Risk Cardiovascular Patient Population

Purpose: To describe the development and daily operations of Project PURPOSE, a pharmacy resident-run transitions of care (TOC) pilot program, in a high risk cardiovascular (CV) patient population at a tertiary academic medical center.

Summary: As part of a newly established post-graduate year 2 (PGY-2) TOC residency program at our institution, a 6 month resident-run TOC pilot service was developed for high risk CV patients. The TOC pharmacist intervention took place either prior to a patient’s ambulatory CV appointment or during the patient’s hospital admission. In both cases, the following activities were completed: best practice medication history, distribution of adherence tools, triage and resolution of medication access issues, and recommendations for drug optimization following a full pharmacotherapy review. For admitted patients, additional services included discharge medication counseling, medication bedside delivery and post-discharge phone calls. Once the patient received the pharmacist intervention either in the ambulatory or inpatient setting, the patient was followed by a TOC resident for the duration of the pilot.

Metrics collected included number of unplanned hospital readmissions, time to healthcare utilization and change in patient activation score. Additional data included number of medication discrepancies identified, percentage of therapeutic recommendations accepted by a provider, number of medication access issues resolved, patient cost savings, patient satisfaction and average length of time spent by the pharmacist on each patient encounter.

Conclusion: Project PURPOSE demonstrates how a residentrun TOC program can be utilized to expand the role of the pharmacist at a tertiary academic medical center.

Author(s): Gillis C, Dempsey J, Sibicky S, Matta L, MacRae C, Kirshenbaum J, Faxon D, Churchill W

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