Pharmacist medication review: An integrated team approach to serve home-based primary care patients

Abstract

Background Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a cohort of medically complex home-based primary care (HBPC) patients. Method Ninety-six medically complex patients were assessed for medication-related problems. Data collected on these patients were: number of chronic conditions, number of medications, appropriate indication for each medication, dose appropriateness, drug interactions, recommendations for medication optimization and deprescribing. The number of accepted recommendations by the HBPC practice was analyzed. Results On average, the patients were 82 years old and had 13 chronic conditions. They were taking a median of 17 medications. Over a four-month pilot period, 175 medication recommendations were made, and 53 (30.3%) of them were accepted, with most common being medication discontinuation, deprescribing, and dose adjustments. Sixty-four (66.7%) patients were on a medication listed as potentially inappropriate for use in older adults. The most common potentially inappropriate medication was a proton-pump inhibitor (38.5%), followed by aspirin (24%), tramadol (15.6%), a benzodiazepine (13.5%) or an opioid (8.3%). Eighty-one medications were recommended for deprescribing and 27 medications were discontinued (33.3%). There were 24 recommended dose adjustments and 11 medications were dose adjusted (45.8%). Thirty-four medications were suggested as an addition to the current patient regimen, 2 medications were added (5.9%). Conclusion Pharmacist comprehensive medication review is a necessary component of the HBPC healthcare continuum. Additional research is needed to examine whether aligning pharmacists to deliver support to HBPC improves clinical outcomes, reduces healthcare expenditures and improves the patient’s experience.

Home-based primary care visits by nurse practitioners

“…Given the increasing need for home-based health care and the essential roles NPs play in home health care, it is important to understand the scope and nature of NP home visit interventions and associated outcomes. Also, NP interventions in transitional care have been studied extensively and included in two of the aforementioned reviews (Mora et al, 2017; Osakwe et al, 2020). Hence, the purpose of this systematic review is to synthesize the research evidence of NP visits in home-based “primary” care.…”

“…However, the nature and scope of NP home visits were not clearly described in the review. In an integrative review, Mora et al (2017) reported that NP interviews (although not exclusively led by NPs) resulted in reduced hospital readmission rates. However, the review addressed NP interventions exclusively within the context of transitional care.…”

Pharmacist Intervention in Portuguese Older Adult Care

“…The medicine review service allows one to identify and help to solve issues with adherence to therapy, dosing, unintentional duplications, adverse reactions, drug interactions, and incorrect dosage, among others [ 94 ]. By assisting patients in managing their therapeutic regimens, pharmacists can help to reduce medication errors and contribute to increased adherence to therapy.…”

“…By assisting patients in managing their therapeutic regimens, pharmacists can help to reduce medication errors and contribute to increased adherence to therapy. As integrated members of multidisciplinary teams, they can easily share patient-related information with other health professionals and help improve patient care [ 94 , 95 ].…”

Polypharmacy in the Homebound Population

“… 4 In another study, the median number of medications in a homebound population was 17. 5 Polypharmacy can lead to confusion, errors, medication nonadherence, medication interactions, adverse medical events, higher costs, increased caregiver stress, and a decrease in overall quality of life for the homebound individual.…”