Expanding care through a layered learning practice model.
OBJECTIVE
The outcomes of a patient-centered layered learning practice model (LLPM) in which the clinical specialist acted as the attending pharmacist and managed a pharmacy team to provide direct patient care were evaluated.


METHODS
Two 30-day evaluations were conducted on the acute care malignant hematology and medical oncology services of the University of North Carolina Medical Center in 2011. The primary objective of this study was to design an LLPM that used a team to expand the pharmacist care services offered. The primary outcome was the frequency of pharmacy team encounters at discharge (medication reconciliation and counseling), termed the discharge capture rate.


RESULTS
During the study months, 42 and 78 malignant hematology and medical oncology patients were eligible for study inclusion, respectively. The overall discharge capture rate was 51%. Sixty-one patients received discharge medication reconciliation services during patient counseling. Patients included in the malignant hematology group received a mean of 11 prescriptions at discharge, compared with 9.83 in the medical oncology group. Means of 1.26 and 2.1 medication-related problems per patient were identified in the malignant hematology and medical oncology studies, respectively, during discharge medication reconciliation. The overall mean face time spent per patient was 21.3 minutes.


CONCLUSIONS
Patients in malignant hematology and medical oncology services were counseled and provided discharge medication reconciliation by a pharmacy student or resident whose activities were managed and reviewed by an attending pharmacist using an LLPM, resulting in an improvement in all clinical outcomes and measures.
University of North Carolina Medical Center, Chapel Hill, NC jill.bates@unchealth.unc.edu.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC. jill.bates@unchealth.unc.edu.
Jill S
JS
Bates
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Larry W
LW
Buie
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Lindsey B
LB
Amerine
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Scott W
SW
Savage
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Stephen F
SF
Eckel
University of North Carolina Medical Center, Chapel Hill, NC.
Rachana
R
Patel
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
John M
JM
Valgus
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Kamakshi
K
Rao
University of North Carolina Medical Center, Chapel Hill, NC.|University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Rowell
R
Daniels
D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D059065:Medication Reconciliation / Q000379:methods*; D008875:Middle Aged; D017145:Models, Educational; D009369:Neoplasms / Q000628:therapy; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods; D018802:Patient-Centered Care / Q000379:methods; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000379:methods*; D024382:Professional Role