Introduction Pharmacists play an important role in helping patients manage their medications across the continuum of care. Pharmacist home visits support continuity of care and provide a unique opportunity to identify medication‐related problems. Objective The primary objective of this study was to describe a cohort of patients who received home visits and the subsequent actions taken by the pharmacist towards the goal of optimizing medication regimens. The evolution of the service is also described. Methods A retrospective chart review was used to gather demographic information. Clinical documentation was reviewed to gather information on medication problems identified by the pharmacist and recommendations made to prescribers. Institutional and city databases were used to collect data on readmissions and socioeconomic status, respectively. Descriptive statistics were used to analyze data. Results Between February 2012 and December 2018, 485 home visits were conducted. Patients were taking a mean of 13 (SD ±5.5) medications; 1890 medication discrepancies were identified and 862 recommendations were made to prescribers. The relative risk reduction in readmissions for those patients who received a home visit was 6.6%. The average yearly income for citizens who live in neighborhoods where many of the home visits took place was $37 000. Details regarding the evolution of the home visit service were described. Conclusions A large cohort of 485 home visits demonstrated that medications are often not being taken as prescribed, and that the pharmacist is in a unique position to educate patients and work with providers toward the goal of optimizing medication regimens and behaviors. This model of care, focused on high‐risk patients, has been sustained over 7 years. Ongoing efforts are underway to improve communication with prescribers, increase the referral to home visit conversion rate, and enhance longitudinal outcome tracking. Opportunity exists to further expand the service through partnerships with regional payers.
Objectives: The purpose of this commentary is to describe the Johns Hopkins Home Care Group's (JHHCG) Community-based Pharmacy Residency Medication Therapy Management (MTM) rotation, summarize adjustments made to the rotation after the onset of the coronavirus disease 2019 (COVID-19) pandemic, describe key learnings from the adjustments, and provide a call to action for other residency programs seeking to improve their rotations amidst pandemic restrictions. Summary: MTM clinical pharmacists at JHHCG collaborate with patients to identify barriers to adherence, review medications, and develop plans for improvement. Through improved medication adherence, the goals for this program are to reduce adverse effects, patient cost, and medical visits or hospital admissions. Central to this practice is the belief that strong patient relationships are necessary to uncover the root cause of medication nonadherence. In Postgraduate Year-1 (PGY-1) community-based pharmacy residency training, new pharmacists learn the value of building relationships with patients and working through complex problems during this clinical experience. By assisting patients with complex medical conditions and social situations, new pharmacists gain skills in patient care, pharmacy operations, and medication access challenges. As the COVID-19 pandemic forced the discontinuation of faceto-face interactions in this setting, rotation experiences for residents were adapted with the goal of continuing high-impact patient interactions and keeping everyone involved safe. Conclusion: Although considerable changes were made to the MTM rotation because of the COVID-19 pandemic, residents were still able to provide meaningful clinical care telephonically and continued to learn valuable patient care skills. Most importantly, high quality care was still delivered to the patients despite considerable challenges. The major challenge for the residents' clinical experiences as a result of the adjustments has been finding an impactful volume of complex patients to enhance their skills. Other residency programs are encouraged to consider three recommendations to improve their rotations moving forward.Published by Elsevier Inc. on behalf of the American Pharmacists Association.
Manfred Buhr (2007) suggested a powerful and subtle critique of European nations. He observed that their histories reveal "a painful process". His antidote is a universalism that takes a deeper understanding of the Enlightenment project of reason. Buhr endorsed emancipation and human dignity through the Enlightenment rationalism of Kant. He allowed for cultural difference in attaining human dignity. Martha Nussbaum devised the Capabilities Approach along Aristotelian lines, to provide a normative account to evaluate human functioning. Capabilities have real life potential for programs that reassess and empower women in the developing world. The literature inspired by this capabilities approach addresses specifi c communities where women were empowered by giving them choices about the quality of their lives in such areas as education, gender relations, activities outside the home, microcredit, and training.
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