Analysis of a Long-Standing Consultant Pharmacy Service in Home Health Care

OBJECTIVE: To analyze the long-term utilization of an on-site consultant pharmacist referral service at a home health care (HHC) agency (HHA) and the medication-related problems in the homebound patients served.
DESIGN: A retrospective, descriptive study reporting the pharmacist's role in providing pharmaceutical care to patients referred by HHC clinicians from 2009 through 2015.
SETTING: A nonprofit HHA in Spokane, Washington, that has utilized a consultant pharmacist service for more than 20 years as part of an academic partnership with Washington State University.
PARTICIPANTS: All patients referred to the pharmacy team were eligible for inclusion in the data analysis.
INTERVENTIONS: Pharmacists provided comprehensive medication management via telephone calls, home visits, and communication with HHA clinicians to resolve clinician-referred problems.
MAIN OUTCOMES: Reason for referral, modality of resolution, number and type of medication-related problems, prescriber response rate.
RESULTS: Of 1,263 referrals, the pharmacy team resolved the case by visiting 421 patients, calling 261 patients, and collaborating with the clinician team for 323 patients; 258 patients declined or were lost to follow-up. The most common problems were the need for education (37%), adverse drug effect (18.8%), and nonadherence (18.4%). The pharmacy team contacted the prescriber 209 times with a 58.4% rate of partial or full acceptance of pharmacy recommendations (nonresponses were counted as not accepted). An additional 265 prescriber contacts were planned to be done by either the patient or HHC clinician.
CONCLUSION: Consultant pharmacists can play an integral role as part of an interdisciplinary HHC team to resolve medication-related problems.