An interesting component of the methods for this pilot project was the analysis of services over time and the determination of whether the pharmacist’s role changed over time. The majority of recommendations were associated with visits 1 and 2. The lower number of recommendations in later weeks reflects the fact that the full medication history and assessment were done during the initial visit, at which time most of the medication- related issues were identified and recommendations made. The pharmacist’s role tended to change during later visits, focusing more on monitoring of any medication changes that occurred on the basis of recommendations during previous visits. This information may be useful in optimizing pharmacists’ involvement in home care.

Almost all visits were conducted in the home setting, rather than by telephone. This reflects to some degree the type or severity of the medication-related issues identified and the patient characteristics that led to the need for a home visit rather than a telephone consultation. For example, for nonadherence with therapy identified at visit 1, subsequent home visits were warranted to allow visual inspection of medication vials, blister packages, dosettes, and the home environment, to fully assess adherence or factors that might represent challenges to maximizing adherence. In addition, the pharmacist visiting the home might have noticed that patients were making food choices that were inconsistent with dietary recommenda­tions made in the structured hospital environment, which might explain uncontrolled hyperglycemia at home for patients whose glucose control was acceptable while in the hospital. Clearly, observation in patients’ homes is a key component of the pharmacist’s assessment, as many clues can be gathered that reflect the patients’ and caregivers’ true abilities to function in the home setting. Finally, for patients with marked visual or hearing impairment, a home visit allowed more efficient commu­nication and information-gathering.An important aspect of evaluating the success of this type of project is the acceptability of the care, particularly when patients are being visited in the privacy of their own homes. The results of the satisfaction survey indicated high satisfaction among both patients and members of the home care team. No formal survey was carried out with physicians, because the combination of a small number of patients and a large pool of physicians meant limited repeat interactions with physicians. However, indicators of support and/or satisfaction for pharmacist involvement with patients receiving home care surfaced during (and after) the pilot project, including referrals initiated by physicians and positive written comments from physicians following receipt of the pharmacist’s recommendations and consultations. viagra plus

One limitation of this pilot project was the small sample size and therefore the inability to evaluate the impact of the pharmacist’s home visits on outcomes such as readmission, visits to the emergency department, and mortality. Moreover, the patients in this pilot project were elderly general medicine type patients receiving care in a home care setting; although the results obtained are probably generalizable to the general patient population, they may not be applicable to specialty populations such as palliative care patients or oncology patients, who may have different medication-related issues and may be receiving different types of post-hospital care (e.g., through specialty clinics). Further research is needed to explore the role that pharmacists can play across different types of home care situations.

This pilot project adds to the Canadian literature base exploring the role of pharmacists in home care. This project was conducted at a single site, and one pharmacist provided all of the services. The model chosen and the resource issues identified may not be similar to those in other jurisdictions with different home care or pharmacy practice models. Nonetheless, the patients who received care in this pilot project had numerous characteristics typical of those commonly seen within the hospital system in Canada (e.g., older age, multiple medications, cardiovascular disease and/or diabetes). The presence of medication-related issues upon hospital discharge within this group of patients emphasizes the key role that pharmacists can play in facilitating a seamless and safer transition from hospital to home. Viagra Online Canadian Pharmacy

As recognized by the ongoing national Safer Health­care Now! campaign, medication reconciliation has been associated with safer health care, lower rates of errors, and improved safety when patients are transferred from one point of care to another within the health care system. In fact, one of the patient safety goals and required organizational practices of the Canadian Council on Health Services Accreditation (CCHSA) related to medication reconciliation is to reconcile medications upon admission to the organization and at referral or transfer within or outside the organization. The CCHSA defines medication reconciliation as a process to ensure the collection and communication of accurate client/patient medication information. The ultimate goal of medication reconciliation is to facilitate continuity of pharmaceutical care for patients or clients on admission, at the beginning of service, and/or at discharge, transition, or end of service (e.g., from hospital to home or to another level of care or service). With this in mind, the incorporation of a pharmacist to assist with patient transition from hospital to home care (and vice versa) could be a key component of improving health care and medication safety across continuums of care in Canada.

CONCLUSIONS

Patients who have recently been discharged from hospital experience a variety of medication-related issues. In this pilot project, many clinically significant recommen­dations that were suggested by the pharmacist to optimize patients’ medication regimens were accepted; the majority of interventions were implemented during the first and second visits. Both patients and other members of the health care team were very satisfied with the provision of clinical pharmacy services as part of home care. discount drugs canda