Delivering domiciliary pharmaceutical care from a health centre pharmacy

Factors associated with the introduction of visiting-pharmacist services in older adults in Japan: A nested case-control study

AIM

To investigate the factors associated with introducing visiting-pharmacist services for community-dwelling older adults in Japan.

METHODS

We conducted a nested case-control study using claims data in a cohort from a city in Tokyo. Patients aged ≥65 years who received visiting-pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month-year. Medical and long-term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long-term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting-pharmacist service introduction.

RESULTS

A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98-31.80) for physicians' home visits, 5.83 (5.08-6.70) for hospitalization, and 4.97 (4.16-5.95) for designated-facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated.

CONCLUSIONS

This study provides insights into the introduction of visiting-pharmacist services for older adults in Japan. Geriatr Gerontol Int 2024; 24: 344-351.

The outcome of domiciliary medication reviews and their impact: a systematic review

Objectives

Medication reviews in the domiciliary setting are becoming more prevalent internationally. Understanding the benefits of these reviews is essential to ensuring quality healthcare services. To date there has not been a systematic evaluation of the outcomes of these services and their impact on patients. A systematic review of the literature was undertaken with a view to understanding the impact of medication reviews in this setting. Controlled and uncontrolled studies were included. Outcomes were categorised according to the ECHO model. A narrative synthesis was developed.

Key findings

Nineteen out of 31 papers included demonstrated an improvement in outcome. Clinical outcomes were the most commonly measured and humanistic outcomes the least commonly measured. Domiciliary medication reviews (DMRs) services are presented as providing benefit. However, it is difficult to quantify the impact of services from the published outcomes.

Summary

Future work should focus on demonstrating the meaningful changes to patients that DMRs have enabled.

Medication review and reconciliation with cooperation between pharmacist and general practitioner and the benefit for the patient: a systematic review

This article systematically reviews the literature on the impact of collaboration between pharmacists and general practitioners and describes its effect on patients' health. A systematic literature search provided 1041 articles. After first review of title and abstract, 152 articles remained. After review of the full text, 83 articles were included. All included articles are presented according to the following variables: (i) reference; (ii) design and setting of the study; (iii) inclusion criteria for patients; (iv) description of the intervention; (v) whether a patient interview was performed to involve patients' experiences with their medicine-taking behaviour; (vi) outcome; (vii) whether healthcare professionals received additional training; and (viii) whether healthcare professionals received financial reimbursement. Many different interventions are described where pharmacists and general practitioners work together to improve patients' health. Only nine studies reported hard outcomes, such as hospital (re)admissions; however, these studies had different results, not all of which were statistically significant. Randomized controlled trials should be able to describe hard outcomes, but large patient groups will be needed to perform such studies. Patient involvement is important for long-term success.

Patients' experiences of a community pharmacy-led medicines management service

Medicines management services provided by community pharmacists have been proposed as one means to ensure that patients receive all the medicines they may benefit from in the English National Health Service. These services may also offer ways of addressing the historic under-utilization of community pharmacists' clinical skills and expertise. Medicines management services differ significantly from the dispensing and medicines sales roles traditionally associated with community pharmacy, particularly in relation to the provision for pharmacists to make recommendations to both patients and doctors about pharmacological treatment and lifestyle management. This paper describes patients' experiences of a medicines management service provided by community pharmacists for people with coronary heart disease, delivered in England. It draws on findings from semistructured, face-to-face interviews with 49 patients recruited from pilot sites delivering the service. Findings suggest that although patients cautiously welcomed the opportunity to consult with a pharmacist about their medicines, they had reservations about them making recommendations about treatment, and many still regarded the doctor as the health professional 'in charge' of their medicines. The implications of these findings are discussed in light of the developing sociological literature on pharmacy and medicines usage.

Clinical Pharmacy Services in the Home: Canadian Case Studies

OBJECTIVES

To describe clinical home care services provided by Canadian pharmacists and to identify facilitators of and barriers to the provision of these services.

DESIGN

Home care practices in Canada were identified using key informant and snowball sampling methods. Case descriptions of each pharmacy were composed using data obtained via a faxed questionnaire and a follow-up telephone interview.

SETTING

Community and institutional pharmacies across Canada.

PARTICIPANTS

Sixteen pharmacists with practices that met three criteria: at least one home visit conducted per week, visits conducted specifically for clinical purposes beyond routine prescription counseling, and documentation of home care services.

INTERVENTION

Faxed questionnaire and follow-up telephone interview.

MAIN OUTCOME MEASURES

Pharmacist characteristics, pharmacy characteristics, types of clinical home care services, home care-related products and dispensing services, referral system, reimbursement, barriers and facilitators, and evaluative strategies.

RESULTS

Twelve practices were in community pharmacies, nine of them independents. Home care services were provided primarily to address noncompliance and at the request of other health professionals. Elderly patients were the predominant service recipients. Services provided in most practices included compliance support, medication regimen review, monitoring of new medications, and patient education and training. Less than one-third of practices compiled evaluative data on these services. Most practices did not bill for services rendered. Lack of reimbursement was cited as the most important practice barrier, and having other sources of funding, such as high prescription revenues, was viewed as the major facilitator.

CONCLUSION

Clinical home care practice is rare in Canadian pharmacy; reimbursement is a major barrier. Practices described in these case studies were initiated to address a perceived important patient need. To enable further dissemination of clinical home care practice, pharmacists need to establish formal linkages with other home care providers, evaluate their services, and use the data obtained to develop marketing and reimbursement strategies.