Objective: To describe the demographic and clinical characteristics of frail and homebound communitydwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate.
Design: Retrospective, cross-sectional chart-review study using data from patient records.
Setting: Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist.
Patients: 171 patients received a HMR between January 1, 2016, and May 31, 2018.
Intervention: Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team.
Main Outcome Measures: Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented.
Results: Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%.
Conclusions: Frail and homebound communitydwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.
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