(Management Case Study) Enhancing Access to Medications for Heart Failure Patients Prior to Discharge by Utilizing Certified Pharmacy Technicians

Purpose: Heart failure is a frequently encountered cardiovascular disease state requiring a multidisciplinary approach to care to reduce morbidity and mortality including hospital readmissions. Prior studies have shown pharmacist involvement in admission medication reconciliation and discharge medication review result in reduced heart failure readmission and costs. Recently, the Cleveland Clinic Main Campus medication reconciliation process has been revised to specifically target heart failure patients and promote coordination between clinical pharmacists and advanced certified pharmacy technicians via the electronic medical record chat function to complete admission/discharge medication reconciliation and medication access prior to discharge.

Methods: A medication error on a heart failure patient sent home with an incorect medication led to review and implementation of a process to improve medication history and reconciliation. Pharmacy services dedicated to transitional care of our heart failure patients include admission medication histories/reconciliation, rounding clinical pharmacists, review of prescription insurance/price checks, diseases state education, discharge medication reconciliation, bedside delivery of homegoing medications, and post discharge follow up.
Beginning in February 2022, certifed pharmacy technicians in advanced roles were trained to work with clinical pharmacists managing our heart failure patient population. The certifed pharmacy technicians work alongside multidisciplinary teams and assist with medication histories, prescription insurance investigation, price checks on new therapies, and discharge coordination to ensure medications are in hand upon discharge. Certified pharmacy technicians were assigned to work with heart failure services to improve on completion rates for medication histories (baseline data = 36%) and communicate with pharmacists to reach a goal of 80% completion. In addition, certified pharmacy technicians were upskilled and trained on proper techniques in virtual communication to address prescribing medication errors when a patient is discharging to ensure adequate access to discharge prescriptions. Processes were set up for communication and documentation in the electronic medical record to address any access concerns with discharge prescriptions.

Results: Since piloting services in first quarter of 2022, there has been improvement in admission medication reconciliation capture rate throughout the year (pilot 36.7% → Q2 63.7% → Q3 68.8% → Q4 71.6%). Technician shortages impacted ability to reach consistent rates beyond 80%, but definite improvement was noted. Admission medication histories completed by certified pharmacy technicians showed an average of 4 of interventions, while identifying medication adherence barriers. In addition, since implementation of these services, prescription capture has increased by 6.5%, resulting in a 54.6% prescription capture for 2022.
Conducting prescription insurance investigations upon admission and price checks on new medications resulted in an 11% increase in prescription capture and smoother discharge process. 41.5% of patients received price checks in Q4 of 2022 with 74% of these being for SGLT2 or ARNI. Ability to perform price checks, specifically ARNI and SGLT2 inhibitors, has aided in the process of decreasing delay in discharge and improved the process of getting access to those medication therapies to patients. Certified pharmacy technicians are trained on submitting prior authorizations, locating and identifying prescription savings plans, and identifying patient’s deductible if applicable.

Conclusion: The ability to have certified pharmacy technicians in an advanced roles to address early intervention during the admitting phase of a patient’s admission has led to an improvement in completion of admission medication histories with an average of 4 interventions per patient. This process also led to improvements in access to high-cost medications for heart failure (SGLT2 and ARNI) as well as an increase in homegoing prescription capture rate.