A Randomized, Controlled Pragmatic Trial of Telephonic Medication Therapy Management to Reduce Hospitalization in Home Health Patients

Zillich, Alan J.; Snyder, Margie E.; Frail, Caitlin K.; Lewis, J. B.; Deshotels, Donny; Dunham, Patrick; Jaynes, Heather A.; Sutherland, Jason M.

doi:10.1111/1475-6773.12176

Cited by 37 publications

(67 citation statements)

References 23 publications

(35 reference statements)

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“…[13][14][15] The optimal service delivery model for pharmacists working in home care remains unclear; both home visits and telephonebased practices have been described. [6][7][8]16,17 Home care clinicians in the Winnipeg Regional Health Authority (WRHA) currently rely on community pharmacists for assistance with medicationrelated issues. Community pharmacists are limited in terms of the patient information that is available to them, which can affect their ability to make prescription changes.…”

Section: Résumémentioning

confidence: 99%

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Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program

Walus

Woloschuk

2017

CJHP

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Background: Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. Objectives: The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. Methods: The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. Results: A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. Conclusions:The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research is warranted to determine the optimal pharmacy service for home care patients and the most appropriate cpKPIs to measure its effects.

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Section: Résumémentioning

confidence: 99%

“…[6][7][8]16,17 The ideal distribution of clinical activities for home care pharmacists remains unknown. Clinical pharmacy key performance indicators (cpKPIs) have been developed to guide pharmacist duties in acute care, and these measures have been shown to improve patient outcomes.…”

Section: Résumémentioning

confidence: 99%

Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program

Walus

Woloschuk

2017

CJHP

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“…9 This secondary analysis was approved by the Purdue University Institutional Review Board. As the primary outcome was defined as a dichotomous variable, once an ED visit occurred, any additional ED visits were censored.…”

Section: Discussionmentioning

confidence: 99%

“…Additional telephone follow-up was provided as needed per the pharmacists' discretion during the first 30 days of the 60-day home health care episode. 9 …”

Section: Interventionmentioning

confidence: 99%

The Effectiveness of Pharmacist-Provided Telephonic Medication Therapy Management on Emergency Department Utilization in Home Health Patients

Gernant

Snyder

Jaynes

et al. 2016

Journal of Pharmacy Technology

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Background: Preventable emergency department (ED) use may be targeted with interventions for improving the medication use process, as medication misadventures and nonadherence frequently cause preventable ED utilization. One intervention that could prevent ED visits is medication therapy management (MTM). Objective: To evaluate the effectiveness of a telephonic MTM service on reducing ED utilization within a Medicare-insured home health population. Methods: This was a secondary analysis of data from a cluster-randomized controlled trial examining hospitalizations among Medicare-insured patients within 40 randomly selected, geographically diverse, home health centers. The intervention consisted of an initial telephonic medication reconciliation with a pharmacy technician, a telephonic pharmacist-provided medication review, and follow-up pharmacist phone calls. The primary outcome of this analysis was 60-day all-cause ED utilization. Patients’ baseline risk of ED utilization was calculated, and patients were stratified into quartiles based on their baseline risk of ED utilization. Adjusted odd ratios of ED utilization were calculated. Results: Data from 656 patients (intervention n = 297, usual care n = 359) were available for this study. Overall, the MTM intervention was not associated with 60-day ED use, as 24.4% of intervention patients and 25.1% of usual care patients utilized the ED (adjusted odds ratio = 1.11; 95% confidence interval = 0.79-1.57). However, there was lower ED utilization among patients in the lowest risk-quartile (adjusted odds ratio = 2.52; 95% confidence interval = 1.15-5.49; P = .02). Conclusion: This pharmacist-delivered telephonic MTM program did not decrease ED utilization overall in a Medicare-insured home health population, but may further reduce the risk of ED utilization among patients who are at lower risk of utilization.

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“…[4][5][6][7] Results from the trials referenced in the literature are mixed: some report that telemedicine and in-home care have increased patient compliance and the overall power of the study to derive clinically significant results from the data, 4,6,[8][9][10][11][12][13][14] whereas others have not observed differences. 5,15 A 2014 CenterWatch study on in-home nursing services in clinical research found that the adoption and use of MN services is expected to grow; although the costs are somewhat greater than that of traditional clinical trials, in-home clinical trials have faster enrollment rates and higher retention and compliance rates, and overall drug development cycle time metrics decrease. 2 Whereas the CenterWatch report contains qualitative information on the use of MN services to conduct in-home clinical trials, currently no quantitative data existed that captured global industry-wide MN service usage in clinical trials.…”

Section: Introductionmentioning

confidence: 99%