Evaluation of pharmacy resident and student recommendations made before and after home-based primary care patient visits.

Objective: To compare the types of recommendations documented in pharmacy resident and student home-visit notes with those made in the electronic medical record-based drug regimen review (DRR) notes.

Setting: San Francisco Veterans Affairs Medical Center (SFVAMC), San Francisco, California.

Practice Description: The SFVAMC Home-Based Primary Care (HBPC) program provides primary care services through an interdisciplinary team. The pharmacist performs a DRR-a federally required, quarterly retrospective review of the medications for each patient enrolled in the HBPC program and acts as a preceptor for pharmacy residents and students helping to provide patient care.

Practice Innovation: Starting in 2008, residents and students began making home visits with the HBPC primary care providers. Activities and recommendations were documented in a home visit clinical note.

Main Outcome Measures: Number and types of recommendations documented during the DRR and in the home visit notes as well as the clinical change in disease states based on the accepted recommendations.

Results: Ninety-three recommendations were accepted: 27 DRR recommendations and 66 home visit recommendations from August 1, 2008, to July 31, 2009. The most commonly accepted DRR recommendations were to evaluate response to therapy (29%) and home visit recommendations to document medications not listed in the medication profile (26%). Clinical change in disease state based on the majority of the accepted recommendations remained unchanged for both DRR and home visit recommendations.

Conclusion: Home visits by pharmacy residents and students resulted in a greater number and different type of recommendations documented in their home visit notes compared with those in the DRR notes.