Impact Analysis of a Pharmacist-Led Home-Medication Review Service Within an Interprofessional Outreach Team
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.
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.
Keywords: Drug therapy problem; Geriatric pharmacy; Home medication review; Medication therapy management; Pharmacist intervention
Document Type: Research Article
Affiliations: 1: 1University of Toronto, Toronto, Ontario, Canada.. 2: 2Rexall Pharmacy, Toronto.
Publication date: 01 March 2021
- The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Senior Care Pharmacist® will want to consider joining ASCP.
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