Abstract
Initiative objective:
The primary focus of this innovative medication management service involves pharmacists visiting patients recently discharged from a hospital. Four pharmacists in the FHA identify patients at high risk for a medication-related problem, and perform a home visit medication review with a goal of minimizing hospital readmission.
Target groups:
Patients eligible for a home visit are those who are at least 65 years and discharged on at least 6 regularly scheduled medicines. The pharmacists also see patients referred from other sources, such as Home Health, in each of their communities, and from the Elder Health Program.
Initiative activities:
During the first year of the program, 483 patients received a home visit. There were 681 home visits, during which the pharmacists made 1685 recommendations for medication regimen changes, with 1244 being accepted. The pharmacists provided medication education during 605 visits, cleared medicine cabinets during 190 visits, recommended a compliance aid during 260 visits, and requested laboratory testing after 126 of the visits. During 244 of the home visits, the pharmacists performed a nonpharmacological intervention such as checking blood pressure or blood glucose, requesting special authority for medicines, reporting an adverse drug event, or referring the patient to another health care provider.
Initiative deliverables and implications for pharmacy practice:
Pharmacists' recommendations had an acceptance rate of 74%. Preliminary data analysis at 30, 90, and 180 days after pharmacist visits have shown reduced hospitalization rates and a cost savings. Medication management program results will be used for the planning of an expansion of this progressive patient-pharmacist program to other Fraser Health Authority communities, while a further evaluation of the economic and humanistic outcomes is also planned.
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