Standardizing hospital pharmacy practice in home hospitalization: results from a multidisciplinary Delphi consensus...

The expansion of Home Hospitalization (HH) services has prompted the need for standardized pharmaceutical care models to ensure safe and efficient medication management in the home setting. However, Hospital Pharmacy (HP) departments are often heterogeneously involved in HH programs, and there is a lack of consensus on their roles and responsibilities. The objective was to develop a consensus-based activity dashboard to guide HP departments in implementing standardized pharmaceutical care within HH units in Spain.

A modified Delphi method was conducted in five phases: constitution of a coordinating group, definition of candidate activities, selection of a national expert panel, evaluation of the list of activities (two-round consensus process), and analysis of the results. Experts rated the necessity and feasibility of implementing 44 proposed activities by an HP department, using a 9-point Likert scale (in total, 88 items were rated). Activities were included in the final dashboard if ≥75% of panelists rated both dimensions in the 7-9 range.

A total of 23 multidisciplinary experts participated in the Delphi panel. Consensus was achieved for 60 out of 88 evaluated items (68.2%), with 17 activities rated as both necessary and feasible for inclusion in the final dashboard. These activities spanned six domains: drug dispensing, clinical pharmacy care, risk management, communication and patient education, home administration of antineoplastic agents, and clinical research. Several activities were rated as necessary but lacked feasibility consensus, highlighting systemic and resource-based limitations.

This study provides the first structured consensus on pharmaceutical care activities in HH in Spain, resulting in a practical dashboard to guide HP departments. Its implementation may facilitate the harmonization of care models, may enable the optimization of medication safety, and may support the growing role of pharmacists in home-based care. Addressing feasibility barriers is essential to fully realize the potential of pharmaceutical care in HH programs.