A discharged from hospital (McGowan P, Green L, Beattie BL, Chappell N, Clarke H, Gayton D, et al. High-risk patient intervention program. Summary of evaluation results. Vancouver [BC]: University of British Columbia, Institute of Health Promotion Research; 2001 Oct. Unpublished report). Their report highlights a reduction in hospital visits and a net saving per patient with this form of intervention. In Canada, the idea of pharmacists providing clinical services in the patient’s home is relatively new, as pharmacists have typically focused on acute care settings (e.g., hospitals), chronic care settings (e.g., nursing homes), and community settings (e.g., community pharmacies or ambulatory clinics). However, a variety of studies from other countries have addressed this concept. These studies have had various patient populations, interventions, and outcomes, but they have generally shown a positive impact of pharmacist involvement. For example, Stewart and others have described the impact of a home visit by a pharmacist or nurse about 1 week after hospital discharge for patients with heart failure. The visits positively affected patient outcomes such as unplanned readmissions and out-of-hospital deaths, as well as the number of hospital days for readmissions (unplanned and elective). In contrast, the HOMER randomized controlled trial published in 2005 showed, counterintuitively, that pharmacist medication reviews conducted in the homes of elderly patients who had recently been discharged from hospital were associated with an increased risk of hospital readmissions.
In contrast to the relative scarcity of data evaluating the impact of pharmacists in home care, ample evidence is available to support the clinical roles of pharmacists in the hospital setting and in a variety of outpatient settings. Various studies have demonstrated that pharmacist interventions in these settings have positive effects on outcomes such as mortality, length of hospital stay, medication error rates, and costs.
Given the extensive work demonstrating the positive impact of clinical pharmacy services across a variety of settings, the present project was undertaken to investigate the impact of providing such services in the home care setting. To this end, the Pharmacy Services department at the authors’ institution realigned resources to create a 0.5 full-time equivalent (FTE) pharmacist position. This position was used, in the context of a pilot project, to provide clinical pharmacy services to patients who had recently been discharged from hospital. Apcalis Oral Jelly
The primary objective was to characterize the impact of clinical pharmacy services in the home care setting by determining the rate of identification of medication- related issues by the pharmacist, the acceptance rate of the pharmacist’s recommendations, and the clinical significance of the pharmacist’s recommendations. The secondary objectives were to determine the types of clinical pharmacy services performed, the resources required to provide such services at different stages after discharge from hospital, and the levels of satisfaction with the clinical pharmacy service among patients and the rest of the health care team.