When patients are discharged from the hospital with a variety of medication changes, this can lead to confusion – and that has the potential to negatively affect their health and increase the likelihood of their ending up back in the hospital. People with multiple health conditions are especially at risk of being readmitted to the hospital. Not only is this bad for patients, it’s also a big factor driving up the cost of health care.
That’s why the Iowa Healthcare Collaborative (IHC) recently awarded a $15,000 grant to support a program in which a faculty member and student pharmacists of Drake University’s College of Pharmacy and Health Sciences will counsel patients at the Des Moines University family medicine clinic. It came about thanks to the two institutions’ efforts to foster students’ interprofessional learning: Drake pharmacy students began working with clinicians, DMU students and patients in the DMU Clinic in 2017. Now the grant will facilitate more structured, cohesive efforts to follow up with patients after they’ve left the hospital.
“We work together to provide a transition of care for patients being in the hospital, where they’re handed a pill cup, to being at home, where they have to manage on their own,” says Megan Johnson, M.S.N., practice manager in the family medicine clinic. “They may have old and new medications and are confused about what to take. We want to see them seven to 14 days after they’ve been discharged to help alleviate any confusion and answer their questions.”
IHC is a provider-led and patient-focused nonprofit organization that works to promote a culture of continuous improvement in health care. It was created in 2004 through a partnership between the Iowa Hospital Association and the Iowa Medical Society to put health care providers in leadership positions to drive clinical improvements. Its grant to DMU and Drake allows Michelle Bottenberg, Pharm.D., BCPS, associate professor of pharmacy practice at Drake, to be in the family medicine clinic with Drake pharmacy students to review the medications of patients recently discharged from the hospital.
“Pharmacists are uniquely qualified to look at medications and perform a reconciliation of what patients received in the hospital compared to what has been prescribed to them and what they take at home,” she says. “We’re trained to also ask patients whether they take herbal products, over-the-counter medications, vitamin supplements or samples from other providers that can lead to major interactions with their prescribed medications.”
A major barrier to that being a standard of practice is that key sections of the Social Security Act, which determines eligibility for health care programs such as Medicare Part B, omits pharmacists as health care providers, so they’re not able to be reimbursed for the clinical services they provide.
“We’re trying to get away from fee-for-service health care to a more value-based system, but we’re not getting paid that way yet,” Bottenberg says. “The grant is part of that transition to leveraging all our professional strengths to always put the patient at the center of care.”
In addition to benefitting patients, the DMU-Drake collaboration lets students of both institutions learn from each other. Students in the third year of Drake’s four-year pharmacy program work with DMU clinicians and students as well as patients in DMU’s family medicine clinic every Wednesday and Friday.
“The goal is to have a team working together to help patients avoid being readmitted to the hospital,” Johnson says.
The IHC grant brings a third benefit: It connects the DMU Clinic to six other clinics in Iowa that also received it the grant, one of which uses the same electronic health record (EHR) system. That fosters even more interprofessional education and interaction.
“The Iowa Healthcare Collaborative is truly collaborative,” Johnson says. “The other clinic uses the EHR system in ways we don’t, and everyone is willing to share ideas for making the best use of it.”
Overall, the IHC grant supports the goal shared by DMU and the Drake’s pharmacy program – to educate students to be part of health care teams that provide the best possible patient care.
“We are both health care programs and educators. We are pushing the future for our students,” Bottenberg says. “The grant represents another way we are preparing them for that future.”
