When applying for the grant for Realo Discount Drug’s Transition to Wellness Program, Christina Nunemacher's goal was to show that involving pharmacists in the hospital discharge process could lower readmission rates.
A clinical pharmacist at Realo Discount Drug, an independent chain pharmacy in Jacksonville, North Carolina, has created a model for successful integration of a community pharmacist utilizing a grant from the Community Pharmacy Foundation (CPF).
Christina Nunemacher, PharmD, BCGP, a clinical pharmacist at Realo Discount Drug and board-certified in geriatric pharmacy, has an extensive pharmacy background in both hospital and chain pharmacy. At Realo, Nunemacher works with provider and hospital partners to maintain quality clinical services on a fee-for-service basis.
Ashley Abode, PharmD, clinical services director at Realo, told Nunemacher about grants available through CPF—a nonprofit organization led by executive director Anne Marie (Sesti) Kondic, PharmD—that supports the advancement of practice in community pharmacy. At the time, Nunemacher had been in close conversation with the local hospital, Onslow Memorial Hospital, in Jacksonville, NC, and she knew that as community care providers, they could brainstorm and solve patient problems together.
When applying for the CPF grant for Realo’s Transition to Wellness Program, Nunemacher's goal was to show that involving pharmacists in the hospital discharge process could lower readmission rates. Patients were confused about disease management and the importance of their prescribed medications. Many patients were not even picking up their medications upon discharge. Nunemacher knew that involving pharmacists in the process would help solve this problem.
Once the Transition to Wellness Program was in place, pharmacists and residents would follow the enrolled patients from admission, throughout the hospital stay, and after discharge. At the time of discharge, Realo pharmacists complete adherence packaging. Then, a pharmacy resident delivers the medications to the patient’s bedside and provides extensive counseling.
Realo pharmacists ensure that their patients have the necessary appointments scheduled and transportation available. The pharmacists and residents look at all pieces of the puzzle, and if anything is missing, collaborate with the physician.
“We look at all of the social determinants of health,” Nunemacher said. “Does a heart failure patient weigh himself every day and have a scale at home? Does the COPD patient have a rescue inhaler and a plan?”
According to Nunemacher, doctors and hospital staff “have been amazingly supportive and enthusiastic—they want what is best for the patient.” The hospitalists respect the pharmacy team and often come to them for help.
“When the chief hospitalist asked, ‘can you help me with my patient?’, it was an amazing feeling,” Nunemacher said.
Nunemacher credits her PGY-1 residents Sara Jones, PharmD, Sha-Phawn Williams, PharmD, and Melissa Beers, PharmD, for being instrumental in the Transition to Wellness Program and in the development of other clinical services. Once the service was up and running, Nunemacher depended on her residents to carry out the daily execution—handle referrals, visit patients, make follow up calls, and coordinate prescriptions and adherence packaging—while she moved on to the next steps: evaluating progress and creating new services.
In terms of the original goal of lowering hospital readmission rates, Nunemacher reported that the rates have decreased, but there were not enough patients enrolled to show the impact for which she had hoped.
“There was no question that it made a difference,” she said. “Changing the entire process was more of a marathon than a sprint.”
From her work with the Transition to Wellness Program, Nunemacher said she realized that community pharmacists are not being utilized enough.
“We should never be left out of transition of care conversations. Community pharmacists are a secret weapon,” she said.
Nunemacher acknowledged that getting paid for services in today’s market is extremely difficult and takes a lot of creative thought. She noted that her team did not get paid by the hospital for the program, but that when the team showed how much they could contribute, providers began to approach the pharmacists for paid partnerships, seeking help with chronic disease management and wellness visits.
In thinking about quality measures and value-based care, Nunemacher suggests making connections with local doctors and home health care aides, and explain what kind of services a pharmacy can provide to help them.
Nunemacher also recommended having students on rotation from pharmacy schools and training them well. “They can help extend your reach,” she said.
The hospital often calls Nunemacher, asking her to send students to help with health fairs. A PGY-1 residency is a very valuable asset to an independent pharmacy in particular. “These students come out of school, clinically trained and enthusiastic.”
Nunemacher acknowledges the importance of word of mouth. “Once people realize the level of excellent care your pharmacy provides, the prescriptions and compensated clinical services will naturally follow.”
Nunemacher’s urged pharmacists to be innovated. “We need to think out of the box, look at the broad landscape. Make connections. Little things can go a long way—think beyond the brown bag. Everyone needs to see us as service providers, not as dispensers,” she said. “Show fellow health care providers what we can do as a valuable member of the patient care team.
“Patients just need that extra touch, and who better to do that than their local community pharmacist?”