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

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.

Discharge Home From Hospital: How DIRE Can It Be?

Aim: An easy-to-use "DIRE" questionnaire tool was developed to predict an adverse event (AE) within 30 days following discharge from a hospital to the community, among frail elderly individuals aged 65+ years.

Methods: Hospital-administered RAI-HC (Residential Assessment Instrument for Home Care) assessment data from 1,433 individuals were used to develop the tool.

Results: The DIRE tool outperformed two other instruments that have been used to predict risk in similar populations.

Satisfaction survey for a medication management program: satisfaction guaranteed?

Background: Providing clinical pharmacy services to patients in their homes after discharge from hospital has been reported to reduce health care costs and improve outcomes. The Medication Management Program of the Fraser Health Authority involves pharmacists making home visits to provide clinical pharmacy services to elderly patients who have recently been discharged from hospital and others considered to be at high risk for adverse drug events. Although clinical and economic outcomes of this program have been evaluated, humanistic outcomes such as satisfaction have not been assessed.

Pharmacists making house calls: innovative role or overkill?

Background: The Medication Management Program was established at the Fraser Health Authority in 2005, in response to evidence suggesting that having pharmacists provide care to patients in their homes after discharge from hospital could reduce subsequent utilization of health service resources.

Objective: To determine the effectiveness of the Medication Management Program in its first 2 years of operation.

Methods: For patients who had received a home visit by a pharmacist, the utilization of health services (admissions to hospital, physician office visits, and dispensed medications) in the year before the home visit was compared with utilization during the year after the intervention.

Pharmacists' participation in an inhaled respiratory medication program: reimbursement of professional fees.

Background: An intervention (termed Initiative) was initiated to facilitate converting beneficiaries of a public drug insurance program in the province of Nova Scotia from respiratory nebulization medications to inhalers. Community pharmacists provided patient education and billed professional fees for conversions or optimizing inhaled respiratory medication technique.

Objective: To determine community pharmacists' self-reported participation rate and identify facilitators and barriers to billing for professional fees.

Use of gastrointestinal preventive therapy among elderly persons receiving antiarthritic agents in Nova Scotia, Canada.

Background: Two different strategies, referred to as gastrointestinal (GI) preventive therapy (GIPT), have been recommended for high-risk patients to prevent GI complications associated with antiarthritic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs): (1) use of a gastroprotective agent (GPA) along with the NSAID or (2) use of a cyclooxygenase-2-selective inhibitor (COX-2SI). The COX-2SIs rofecoxib and celecoxib have been shown to be as effective as traditional NSAADs for pain relief, but with an improved GI safety profile.

Objective: The purpose of this study was to examine the utilization of GIPT by elderly persons in Nova Scotia who were taking antiarthritic medications and to identify the factors associated with their use of GIPT.

Validation of four clinical indicators of preventable drug-related morbidity.

Background: Clinical indicators are tools that assess quality issues related to the use of medicines. At this time, validated clinical indicators for preventable drug-related morbidity (PDRM) are lacking.

Objective: To assess the validity and reliability of using population administrative claims data to identify the extent of PDRM in older adults in Canada.