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      Current perspectives on pharmacist home visits: do we keep reinventing the wheel?

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          Abstract

          The scope of clinical pharmacy services available in outpatient settings, including home care, continues to expand. This review sought to identify the evidence to support pharmacist provision of clinical pharmacy services in a home care setting. Seventy-five reports were identified in the literature that provided evaluation and description of clinical pharmacy home visit services available around the world. Based on results from randomized controlled trials, pharmacist home visit interventions can improve patient medication adherence and knowledge, but have little impact on health care resource utilization. Other literature reported benefits of a pharmacist home visit service such as patient satisfaction, improved medication appropriateness, increased persistence with warfarin therapy, and increased medication discrepancy resolution. Current perspectives to consider in establishing or evaluating clinical pharmacy services offered in a home care setting include: staff competency, ideal target patient population, staff safety, use of technology, collaborative relationships with other health care providers, activities performed during a home visit, and pharmacist autonomy.

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          Most cited references86

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          Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis.

          We set out to determine the effects of pharmacist-led medication review in older people by means of a systematic review and meta-analysis covering 11 electronic databases. Randomized controlled trials in any setting, concerning older people (mean age > 60 years), were considered, aimed at optimizing drug regimens and improving patient outcomes. Our primary outcome was emergency hospital admission (all cause). Secondary outcomes were mortality and numbers of drugs prescribed. We also recorded data on drug knowledge, adherence and adverse drug reactions. We retrieved 32 studies which fitted the inclusion criteria. Meta-analysis of 17 trials revealed no significant effect on all-cause admission, relative risk (RR) of 0.99 [95% confidence interval (CI) 0.87, 1.14, P = 0.92], with moderate heterogeneity (I(2) = 49.5, P = 0.01). Meta-analysis of mortality data from 22 trials found no significant benefit, with a RR of mortality of 0.96 (95% CI 0.82, 1.13, P = 0.62), with no heterogeneity (I(2) = 0%). Pharmacist-led medication review may slightly decrease numbers of drugs prescribed (weighted mean difference = -0.48, 95% CI -0.89, -0.07), but significant heterogeneity was found (I(2) = 85.9%, P < 0.001). Results for additional outcomes could not be pooled, but suggested that interventions could improve knowledge and adherence. Pharmacist-led medication review interventions do not have any effect on reducing mortality or hospital admission in older people, and can not be assumed to provide substantial clinical benefit. Such interventions may improve drug knowledge and adherence, but there are insufficient data to know whether quality of life is improved.
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            Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission

            Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society.
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              Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial.

              To determine whether home based medication review by pharmacists affects hospital readmission rates among older people. Randomised controlled trial. Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk. 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge. Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care. Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D. By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, -0.05 to 0.06; P = 0.84, t test). The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review.
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                Author and article information

                Journal
                Integr Pharm Res Pract
                Integr Pharm Res Pract
                Integrated Pharmacy Research and Practice
                Integrated Pharmacy Research & Practice
                Dove Medical Press
                2230-5254
                2018
                01 October 2018
                : 7
                : 141-159
                Affiliations
                [1 ]Pharmacy Community Programs, Lower Mainland Pharmacy Services, Langley, BC, Canada, priti.flanagan@ 123456fraserhealth.ca
                [2 ]Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, priti.flanagan@ 123456fraserhealth.ca
                Author notes
                Correspondence: Priti S Flanagan, Lower Mainland Pharmacy Services, 2nd Floor, 8521 198A Street, Langley, BC V2Y ØA1, Canada, Tel +1 604 455 1328 (ext 741403), Email priti.flanagan@ 123456fraserhealth.ca
                Article
                iprp-7-141
                10.2147/IPRP.S148266
                6171762
                08d54a4b-fb31-44c7-9a17-ee18eee79cd0
                © 2018 Flanagan and Barns. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                clinical pharmacy,home care,home visit,medication review,pharmacist

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