oa Post-discharge phone follow-up: a collaboration for optimizing medications management upon transition of care

Background: Clinical Pharmacists (CPs) have a vital role in the patient transition of care (TOC), including medication reconciliation and counseling upon admission, transfer, and discharge.¹ The Clinical Pharmacy Department at Al Wakra Hospital, Qatar, Hamad Medical Corporation (HMC), established a collaborative practice agreement with the Internal Medicine Department.² The post-discharge phone follow-up (PDPF) telehealth service aimed to maintain patient continuity of care post-discharge and ensure the safety and effectiveness of discharge medication therapy. This audit describes the implementation of a new TOC initiative. Methods: Criteria for PDPF service were developed and documented into a protocol. Patients discharged from medical wards with complex medication therapy or discharged without discharge medications counseling were contacted within 3 to 7 days from discharge. CPs provided phone medication reconciliation, counseling, lifestyle modification education, assessed medication adherence, and communicated identified medication errors to the primary physicians. Data collected from documented pharmacy interventions and PDPF service forms were used for descriptive analysis. Results: From December 2020 to March 2021, 429 patients met the inclusion criteria out of 1,117 discharged patients. CPs conducted more than 613 phone calls with an average of 15 minutes per patient. CPs reviewed 2,471 medications, found 638 pharmacy clinical interventions (Table 1), and approached more than 77 physicians. Out of the 276 patients who completed PDPF service (Figure 1), the average patients’ age was 52 years, 151 (51%) were females, and 85 (31%) were Qataris. Medication assessment by CPs revealed that 87% (n = 235) of the patients were adherent to medications, 20% (n = 56) were confused about discharge medication indications, and 13% (n = 30) experienced adverse drug reactions. Conclusion: There is no standardized or established TOC service utilizing telepharmacy; however, PDPF service expanded the clinical pharmacy role beyond the in-patient services.³ Our plan includes monitoring outcome-based parameters, including post-phone call readmissions rate, 60 days emergency visits, and patients’ satisfaction.