Preliminary findings from a student pharmacist operated transitions of care pilot service.

BACKGROUND AND PURPOSE: Student pharmacists are well equipped to complete transitions of care (TOC) activities. This communication describes the implementation of a student-operated TOC pilot service at a community hospital and explores the clinical and educational findings of such a service.

EDUCATIONAL ACTIVITY AND SETTING: Patients admitted to the hospital were included in the service if they had a primary care provider from an affiliated ambulatory care office. The TOC student pharmacist verified the medication history upon admission, reviewed the inpatient chart during the hospitalization, assessed medication adherence, provided discharge counseling, and prepared a TOC document to share with the patient's ambulatory care office.

FINDINGS: Forty-one patients were followed in the TOC pilot service. Student pharmacists identified 208 medication discrepancies between hospital and ambulatory care medication lists upon admission for 35 of the patients. Review of the discharge medication reconciliation was performed for 31 (75.6%) of the patients prior to discharge. The Adherence Estimator® was performed for 32 (78%) of the patients, with a mean score of 2.2. Student pharmacists anecdotally reported satisfaction with their involvement, and preceptors felt confident that the students were able to serve as an extension of the TOC service.

DISCUSSION AND SUMMARY: Implementation of a student pharmacist-operated TOC service broadened student involvement on advanced pharmacy practice experience (APPE) and improved patient care through resolution of medication discrepancies, reinforcement of adherence, and communication with primary care providers.