Improving Patient Outcomes Through Pharmacist Involvement in Transitions of Care



February 28, 2013

Best Practices from the ASHP-APhA Medication Management in Care Transitions Project

WASHINGTON, DC — The American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) today released a summary report from the Medication Management in Care Transitions (MMCT) Project. ASHP-APhA Medication Management in Care Transitions Best Practices serves as a summary of best practices from current care models and programs that improve patient outcomes by involving pharmacists in medication-related transitions of care.

Preventing costly readmissions and containing health care costs is in the forefront of national concerns. Payers, patients, providers and regulators share a common goal of optimizing care in a reliable, consistent manner. Pharmacists’ extensive education on evidence-based use of medications and their clinical skills position them as integral patient care providers.

Care transitions models involving pharmacists as leaders of the medication-use process are emerging, but have not yet been well-defined. Through the MMCT project, ASHP and APhA partnered to identify and profile existing best practice models involving pharmacists in the care transitions process. More than 80 institutions from across the country responded to the profession-wide call for best practices with models for MMCT. To evaluate the models for best practices, ASHP and APhA assembled expert panels composed of pharmacists skilled in working with MMCT programs. Eight programs were distinguished as best practices. The assessment process focused on three main criteria:

  • Impact of the care transitions model on patient care,
  • Pharmacy involvement in the transition process from inpatient to home settings, and
  • Potential to scale and operationalize the process for implementation by other health systems.

APhA Executive Vice President and CEO, Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, stated, “The eight programs identified in this report should be applauded for their ingenuity and successful use of resources in developing and implementing pharmacist-integrated care transitions programs. Pharmacists are proficient at educating patients to use medications correctly and empowering them to report problems before simple outpatient therapy turns into complex inpatient care. As these programs have demonstrated, fully-integrated, comprehensive pharmacy services can cost-effectively optimize patient outcomes.”

“These best practices provide a powerful illustration of the impact that pharmacists can make as part of interprofessional health care teams,” said ASHP CEO Paul W. Abramowitz, PharmD, FASHP. “Pharmacists’ leadership is integral to improving patient care throughout the entire medication-use process and all care settings. Transitions of care have been identified as critical points that can positively — or negatively – impact patient care outcomes. The programs highlighted in this report demonstrate how to improve medication adherence and reduce adverse drug events and hospital readmissions.”

These best practices programs demonstrated that patients benefit from the pharmacist’s medication expertise on care transitions teams. Contributions by many individuals including pharmacists, technicians, student pharmacists, supportive personnel and other health care providers in these projects are critical to achieving success in improving patient care and outcomes during care transitions. Collaboration and effective communication between all providers on the health care team, both in the inpatient and outpatient settings, is critical to effective care transitions.

There is still much work to be done in developing effective programs that span the various health care settings where care transitions occur. The lessons learned from these programs provide valuable insight for involving pharmacists from other practice settings as new care transitions programs are developed or existing ones are enhanced to expand the reach of care.

ASHP-APhA Medication Management in Care Transitions Best Practices is available, free of charge, at

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