Impact Analysis of a Pharmacist-Led Home-Medication Review Service Within an Interprofessional Outreach Team

Abstract

Objective To describe the demographic and clinical characteristics of frail and homebound community-dwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. Design Retrospective, cross-sectional chart-review study using data from patient records. Setting Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. Patients 171 patients received a HMR between January 1, 2016, and May 31, 2018. Intervention Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. Main Outcome Measures Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. Results Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. Conclusions Frail and homebound community-dwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.

The value of domiciliary medication reviews – a thematic analysis of pharmacist’s views

“…However, this study revealed they also need to be able to recognise and take action to resolve other issues uncovered linked to the wider determinants of health. Recent studies have shown that domiciliary settings result in the identification of more MRPs [ 21 , 22 ]. Being able to address the wider needs of patients during a DMR is a novel insight.…”

Delivery of Pharmaceutical Care at Tertiary Level: From Admission to Home Care

“…Frail and homebound community-dwelling geriatrics were observed to be using a high number of medications and experiencing a significant number of Delivery of Pharmaceutical Care at Tertiary Level: From Admission to Home Care DOI: http://dx.doi.org /10.5772/intechopen.112503 DRPs. Recommendations to optimise medication therapy by community pharmacists can be effectively done by HMR [51]. Likewise, underserved communities in Taiwan had many issues with medications, but with pharmacists' home visits, their knowledge of diseases improved and drug-related problems were mitigated, while drug compliance and drug storage methods were improved resulting in less drug wastage [52].…”

Evaluating Medication Adherence Through Home Medication Reviews in the Paediatric Community: A Cross-Sectional Study.

“…Clinical pharmacist-led medication reviews in pediatric inpatients have shown potential in detecting DRPs, highlighting the importance of involving pharmacists in direct patient care to improve medication safety [9]. Furthermore, an impact analysis of pharmacist-led HMR within an interprofessional outreach team for frail and homebound older adults identified a high number of medications and significant DRPs, indicating that HMRs could be an effective method to optimize medication therapy in the pediatric population as well [10].…”