Implementing Pharmacist-Led Patient Home Visits

Abstract

Introduction Patients with chronic diseases such as hypertension and diabetes often experience difficulties managing complex medication regimens. A promising method for identifying and addressing medication-related problems is pharmacist provision of patient home visits. Pharmacist home visits could alleviate the burden on both patients and providers for the purposes of maintenance medication and goal-achievement assessment. Methods A pharmacist home visit program was developed utilizing social workers to identify patients who would most benefit from a pharmacist home visit. The two pharmacists met with these patients in their homes to evaluate their current medication regimens, adherence, medical condition status, and potential drug-related problems (DRPs). Upon conclusion of the home visit, the pharmacists provided a summary of findings and proposed solutions for identified drug related problems to the patient's primary care provider. Results Fourteen patients participated in pharmacist-provided home visits. During these home visits, 98 unique DRPs were identified. Drug-related problems were grouped into four categories: adherence (n=26, 27%), effectiveness (n=25, 26%), indication (n=24, 24%), and safety (n=23, 23%). Between the initial visit and the final visit, there was a resolution of 25 (26%) drug related problems. Conclusion This project demonstrated a novel referral pathway for identifying patients to participate in pharmacist-led home visits. By providing patient home visits, pharmacists were able to identify and resolve some drug-related problems, but many problems remain unresolved due, in large part, to lack of provider engagement.

A case of pharmacist-led care team interventions to maximize rural patient quality of life

“…This work was possible through a grant-funded project designed to increase rural patient access to quality healthcare. 10 Because this work was funded, the project focus was on demonstrating the benefit of the pharmacist as part of a home visit healthcare team rather than on cost savings or financial benefits. Identifying ways to bill for these services to make this work sustainable beyond the funded project is an ongoing effort.…”

“…In Washington State ongoing work is being conducted to implement comprehensive medication review (CMR) services in rural and underserved communities. 10 As part of a grant-funded project, rural patient CMRs were conducted by a community pharmacist at an outpatient clinic beginning Fall 2019. The project was designed for clinic physicians and nursing staff to identify and enroll up to 50 patients to be referred to a pharmacist for a CMR.…”

Respecting the Patient’s Choice: A Case of Possible Drug-Induced Parkinsonism

“…In a rural, Washington state community, a novel integrated care team including a home health nurse, a hospital pharmacist, and clinic-based physicians developed an interprofessional practice to identify and intervene with high-risk patients cared for in their clinic [ 10 ]. Clinic patients who would benefit from an in-depth medication review by the pharmacist were identified by nurses and physicians.…”

“…At the time of the visit, she was retired, but she had previously been employed as a nurse and, most recently, she was the primary caregiver for her sister until her passing. She was identified by her primary care provider and home health nurse to be a candidate for pharmacist-provided comprehensive medication review (CMR) services [ 10 ]. The patient’s past medical history included diagnoses of angina, asthma, anxiety disorder, chronic neuropathic pain, constipation, depression, diabetes, gastroesophageal reflux disease (GERD), hypertension, insomnia, migraine headaches, muscle spasms, and restless leg syndrome.…”