SHM Converge Scientific Abstract ePoster Gallery-Rx for Success: The Vital Role of Pharmacists in a Virtual Transitions of Care Clinic

Pdf Summary

This abstract describes the role of pharmacists in UC San Diego Health’s Virtual Transitions of Care (VToC) clinic, a hospitalist-led program for high-risk patients after discharge. The clinic aims to reduce medication-related harm, since post-discharge adverse events are common and many are preventable adverse drug events.<br /><br />From January 1 to October 31, 2023, 331 VToC visits involving pharmacists were reviewed retrospectively. Most patients (95%) received a pharmacist pre-visit medication review, while 5% received direct hospitalist consultation. Patients were typically high risk, with a median age of 60, a median LACE score of 63, and a median of 4 medications. English and Spanish were the most common languages.<br /><br />Pharmacist interventions were frequent and varied. The most common was updating the home medication list, followed by coordinating drug access, discontinuing medications, adjusting doses or frequencies, adding medications, preventing or managing adverse drug events, preventing or managing drug-drug interactions, educating patients or caregivers, and handling formulary substitutions. These actions were documented in the electronic health record and used to alert physicians to medication concerns.<br /><br />The authors conclude that pharmacists are essential to patient safety in virtual transitions of care by improving medication accuracy and supporting safe post-discharge management. They also emphasize that collaboration between hospitalists and pharmacists is critical for high-quality care. A future goal is to expand pharmacist support so that all scheduled VToC patients receive pre-visit medication review and/or pharmacist consultation.

Asset Subtitle

Jonathan McIntyre

Meta Tag

Author List Jonathan McIntyre, Maryann T. Ally, Melanie Kwok, Milla Kviatkovsky, Sarah F. Horman, Trina Huynh

Category Innovations

Concept Virtual Transitions of Care Clinic

Concept Pharmacist

Concept Post-discharge Care

Concept Medication List

Concept Adverse Drug Event

Distinguished Non-Finalist

Presenter Organization UC San Diego Health

Presenting Author Jonathan McIntyre

Track Transitions of Care

Keywords

pharmacist interventions

virtual transitions of care

medication reconciliation

post-discharge care

adverse drug events

hospitalist-led program

high-risk patients

electronic health record

drug-drug interactions

patient safety

Virtual Transitions of Care Clinic

Pharmacist

Post-discharge Care

Medication List

Adverse Drug Event