Development and implementation of a postdischarge home-based medication management service

Area of Science:

• Pharmacy practice
• Patient safety
• Healthcare delivery

Background:

• Medication management is crucial for patient safety after hospital discharge.
• Continuity of care during the transition from hospital to home presents challenges.
• Pharmacist-led interventions can optimize medication use and patient outcomes.

Purpose of the Study:

• To describe the development and implementation of a post-discharge, home-based medication management service.
• To evaluate the role of pharmacists in optimizing medication regimens and enhancing patient care continuity.

Main Methods:

• A multidisciplinary work group designed the service structure and training.
• Acute care pharmacists identified eligible patients during hospital admission.
• Pharmacists and pharmacy residents conducted home visits for medication reconciliation, patient education, and comprehensive medication reviews.

Main Results:

• Fifty patients received home-based medication management services.
• Pharmacists identified a median of two medication discrepancies per patient.
• A median of two recommendations for medication optimization were provided to primary care providers per patient.

Conclusions:

• The home-based service enhanced continuity of care during the hospital-to-home transition.
• Pharmacists effectively identified and resolved medication discrepancies.
• Patient education and provider recommendations improved medication management and safety.