Any home care service should follow a collaborative model to ensure that the proper and desired home care solution is provided. This collaboration should also be between the visiting nurse or the home care professional and the college of pharmacy as well.
Ideally, treating a patient involves a series of medication related problems that are common among all home care clients. This is because most of them take a number of medications. In addition to that, almost all of them have very complex medical histories and their health problems make the situations all the more complex.
In such a circumstance, helping the patients manage their medications can really be a challenge for all home care clinicians. It is only when they partner with a college of pharmacy in the community, the agency can successfully follow the medication schedule. Therefore, including a pharmacist as a member of their home care team is so vital.
Medication related problems
In-home care there are bound to be a few medication related problems. This includes both nonadherence to the medication schedule and adverse drug events or ADEs. Such conditions often need hospitalizations of the patients and emergency room visits.
- This is a very common issue with those home care clients who often take multiple medications or
- Those who suffer from a number of chronic diseases and therefore have to use multiple prescribers and pharmacies and
- Those patients who do not have adequate supervision at home as far as taking the medicines on time and as prescribed is concerned.
Specific research has demonstrated that about 30% of all home care clients had experienced possible medication errors. This was found when the medication lists were assessed according to the two basic criteria namely:
- The Beer’s List and
- The Home Health Criteria.
These are actually the consensus-based guidelines for medications used by the home health care services. The risks in it ideally increased with the increase in the number of medications.
Role of the pharmacist in-home care
In order to eliminate the risks, it is therefore important to identify and resolve the medication related problems among the home care clients. This will eventually minimize the chances of hospitalizations and emergency room visits.
It is due to the reason that the pharmacists have a lot of expertise in resolving any medication related issues, the home care agencies usually have a pharmacist integrated within their home care team.
The traditional role of the pharmacist’s in-home care team is usually limited to:
- Monitoring intravenous drug therapy
- Serving as a consultant to the patients and
- Coordinating with the home care clinicians.
Review and other services provided
Ideally, the services provided by the pharmacist may vary by organization but it will typically include a complete medication review. This review may target a few specific conditions such as:
- Congestive heart failure
- Pain and
- Renal insufficiency.
They will also consider the high-risk medications taken by the patient to ensure that their review is complete in all respects. These medications will include:
- Cardiovascular medications
- Nonsteroidal anti-inflammatory drugs and others.
That is not all. Their review will also include important areas of the home care process and therapy provided such as:
- Medication reconciliation
- Suspected adverse drug reactions
- Nonadherence and others.
The pharmacist-led medication reviews may be conducted by a variety of different methods, as well including:
- Chart review
- Home visits
- Telephone interviews and even
- A combination of different methods.
The primary objective of a pharmacist conducting medication reviews is to lessen, if not eradicate, the number of medication related problems. This is something that is defined as any undesirable and unexpected event experienced by the patient that involves or is assumed to involve drug therapy and all those conditions and factors that interfere with the achieving of the desired goals of home care therapy.
Few statistical facts
There are different studies conducted on medical related problems faced by home care patients. According to one such research, it is seen that:
- Out of 20 senior patients receiving home pharmacist-led medication, at least three of them had medication related problems
- One out of three pharmacists visited different homes to resolve these medication related problems and
- The most common problem was that the clients were found taking unnecessary medications.
It was also seen that the number of such unnecessary medications averaged 2.9 per client for one pharmacist visiting the homes of the clients. When the pharmacist intervened, it was found that the number decreased significantly to 1.2.
In another study, it was found that 50% of home care clients who receive care from a pharmacist and nurse collaborative model typically had improved medication use. This was in comparison to the 38% of clients who received home care from a nurse alone.
This shows that there is a significant and attributable improvement in a nurse and pharmacist collaborative care model. This improvement is measured on the basis of the preset criteria that involved:
- Eliminating duplicate therapies
- Achieving the set treatment goals and
- Following the set home care guidelines.
According to the studies and its results, it can be concluded that the pharmacist and nurse collaboration model of home care created the greatest impact on both the therapeutic duplication and improper use of medications.
In a specific analysis of medication reviews conducted by a pharmacist, it was found that most of the nonprofit home care agencies reported medication related problems. Out of the problems identified the research showed that:
- 28% had suboptimal therapy
- 24% used unnecessary drugs
- 38.6% suffered due to discontinuing a drug
- 23.2% due to consulting the prescriber.
Though these comprised the majority of recommendations, there were other related issues as well.
In most cases, it was seen that it is due to the inability of the home care agency to manage the medication related to different issues in the patients. These issues were sometimes found to be major requiring the patients to be hospitalized for further care and relief from the symptoms.