Home Care Pharmacy
Home Care Pharmacy
A clinical pharmacy program was developed at an established home health care (HHC) agency to demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion- related therapies. Initial experiences of this pilot project are described.
Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred to the agency required infusion therapy, multiple opportunities for pharmacist involvement in patient care were identified and a variety of projects were undertaken. A drug information service was developed, a retrospective evaluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitoring was assessed, pharmaceutical care services were provided to patients enrolled in a longterm home care program, a pain management initiative was begun, adverse drug reactions were identified and reported, and pharmacists participated in agency policy development. Preliminary data suggest that pharmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recommendations of which 33% were accepted.
Pharmacists working with a home care agency identified numerous opportunities for improving patient care. Many of the patients receiving home care services were elderly, took a substantial number of medications, and were at risk for drug-related problems and suboptimal therapy.
The provision of clinical pharmacy services is a well-established practice in most health care environments. The literature is replete with examples of the benefits of such services in the hospital setting, and routine pharmacist drug-regimen reviews are federally mandated for patients in nursing homes. However, there exists a group of patients that does not receive an equivalent level of these services, despite receiving advanced levels of care from nurses and other professionals - home health care (HHC) recipients.
Patients receiving HHC services form a distinct population. Like their institutionalized counterparts, they must be appreciably ill to qualify for the services. Likewise, the severity of their conditions often limits their mobility. For example, Medicare, a major payer of HHC services, requires patients to be homebound to qualify for care. But, in contrast to those confined to institutions, HHC patients may receive prescriptions and medications from an unlimited number of prescribers and dispensing pharmacies, and they may receive potentially dangerous nonprescription agents, alternative therapies, and illicit drugs without the knowledge of the prescribers or dispensing pharmacies. Their diets are not directly observed and may impede the provision of optimal medical care. Despite the similarity to institutionalized patients and the potential for experiencing drug-related problems in the home, there exists no standard for clinical pharmacy services for these high-risk patients.
To demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies, the Albany College of Pharmacy initiated a pilot project with an established HHC agency. This report describes the program and some of its results.
A clinical pharmacy program was developed at an established home health care (HHC) agency to demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion- related therapies. Initial experiences of this pilot project are described.
Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred to the agency required infusion therapy, multiple opportunities for pharmacist involvement in patient care were identified and a variety of projects were undertaken. A drug information service was developed, a retrospective evaluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitoring was assessed, pharmaceutical care services were provided to patients enrolled in a longterm home care program, a pain management initiative was begun, adverse drug reactions were identified and reported, and pharmacists participated in agency policy development. Preliminary data suggest that pharmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recommendations of which 33% were accepted.
Pharmacists working with a home care agency identified numerous opportunities for improving patient care. Many of the patients receiving home care services were elderly, took a substantial number of medications, and were at risk for drug-related problems and suboptimal therapy.
The provision of clinical pharmacy services is a well-established practice in most health care environments. The literature is replete with examples of the benefits of such services in the hospital setting, and routine pharmacist drug-regimen reviews are federally mandated for patients in nursing homes. However, there exists a group of patients that does not receive an equivalent level of these services, despite receiving advanced levels of care from nurses and other professionals - home health care (HHC) recipients.
Patients receiving HHC services form a distinct population. Like their institutionalized counterparts, they must be appreciably ill to qualify for the services. Likewise, the severity of their conditions often limits their mobility. For example, Medicare, a major payer of HHC services, requires patients to be homebound to qualify for care. But, in contrast to those confined to institutions, HHC patients may receive prescriptions and medications from an unlimited number of prescribers and dispensing pharmacies, and they may receive potentially dangerous nonprescription agents, alternative therapies, and illicit drugs without the knowledge of the prescribers or dispensing pharmacies. Their diets are not directly observed and may impede the provision of optimal medical care. Despite the similarity to institutionalized patients and the potential for experiencing drug-related problems in the home, there exists no standard for clinical pharmacy services for these high-risk patients.
To demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies, the Albany College of Pharmacy initiated a pilot project with an established HHC agency. This report describes the program and some of its results.