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

Abstract

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.

Current perspectives on pharmacist home visits: do we keep reinventing the wheel?

“…The reported physician acceptance of recommendations varied from 18% to 95%. 14 , 18 , 23 , 24 , 28 , 29 , 42 , 44 , 65 The extent to which communication with prescribers occurred or the suggestions for change that were implemented was not always detailed. Furthermore, pharmacist and physician collaboration may not happen, even if it was the expectation of a program.…”

“…The extent of collaboration can also depend upon the setting from which HV services are offered. Settings identified in the HV literature include: dispensing pharmacy, 24 , 44 , 53 , 58 , 69 , 71 , 76 , 77 , 78 , 84 home care, 28 , 29 , 36 , 46 , 54 , 59 , 65 , 81 , 83 chronic disease management or specialty service, 23 , 25 , 43 , 45 , 48 , 54 , 62 , 75 , 79 , 82 institutional transition service, 22 , 37 , 38 , 40 , 42 , 44 , 63 , 64 , 73 , 74 health care agency, 41 , 52 , 57 , 70 , 72 and primary care. 15 , 20 , 24 , 35 , 39 , 50 , 55 Pharmacists working in health authority or multidisciplinary teams may have more opportunity to establish collaborative relationships; however, collaborative partnerships can also be established in community settings.…”

“… 43 – 65 The post-hospital discharge patient population was the most represented in these articles. 44 , 46 , 48 , 52 – 54 , 59 , 60 , 63 , 64 Other authors describe programs established in community settings 43 , 47 , 49 , 56 , 58 , 61 , 65 and clinics. 45 , 50 , 55 , 57 , 62 Other patient characteristics included being elderly, presence of a chronic disease, or number of medications.…”

“…The majority of these articles describe a program in which a HV was conducted to undertake a MR. 43 – 50 , 52 – 65 The HVs were typically conducted by a pharmacist, with some authors describing the use of pharmacy technicians, 63 , 64 pharmacy students, 50 pharmacy residents/students accompanying a nurse practitioner 57 or a pharmacy resident, or a pharmacist. 59 Onda et al do not specifically describe an intervention; however, a pharmacist-conducted MR is assumed.…”

“…The impact of the HV programs described in these reports were mainly related to identification of DRPs, recommendations made, or medication changes that occurred as a result of the pharmacist’s actions. 44 – 50 , 53 , 55 , 62 – 65 A variety of other impacts were also reported: satisfaction, 43 , 44 , 48 , 52 , 54 , 60 time reduction for other disciplines, 45 ADE identification, 47 , 58 perceptions of program, 51 experience, 61 adherence, 56 , 59 clinical parameters, 55 , 56 and knowledge. 48 , 56 , 60 , 61 Three programs reported economic outcomes including reduced readmission rate 52 , 59 and cost-avoidance.…”