Home-Based Services Improve Health Outcomes

By 2030, 1 in 6 individuals worldwide will be 60 years or older, according to the World Health Organization.¹ As the population of older individuals rapidly grows, chronic health conditions and complex drug therapy regimens also multiply. Medication therapy management (MTM) services are increasingly more critical for older individuals’ care.

Approximately 2 million to 4 million individuals in the United States with chronic conditions encounter obstacles for in-office primary care because they are homebound.² This can lead to increased visits to emergency departments and poor health outcomes.² Pharmacists can help meet patients’ needs by providing home-based MTM services.

Adherence issues and polypharmacy can result in medication- related problems and increase the risk of adverse events.² Advantages of face-to-face MTM consults include³:

• assessment of nonverbal cues to evaluate patients’ understanding of pharmacotherapy regimens;
• development of trust between patients and pharmacists; and use of visual, verbal, and model teaching methods to improve
• adherence (eg, giving the patient printed handouts or demonstrating injection, glucometer, and inhaler techniques).

Home-based pharmacist-led MTM services can provide personalized care to patients who are from underserved communities, homebound because of chronic health conditions, or unable to travel because of transportation issues.² Advantages of face-to-face, home-based pharmacist visits include the ability to view all OTC and prescription medications to assess for adherence, drug interactions, duplication of therapy, and expired drugs (Figure^2,4,5). Pharmacists also get a more complete picture of a patient’s lifestyle to determine strategies that would enhance adherence and have open discussions about diet and exercise. Drug-related problems that are not identified during a typical MTM consult at a community pharmacy may be discovered during a home-based medication review. This information can be conveyed to the patient’s primary-care physician as part of an interdisciplinary approach.

Evidence backs up the pharmacists’ role in home-based MTM consults.^2,4,5 One meta-analysis and systematic review evaluated the effectiveness of pharmacist-led medication reconciliation programs at hospital transitions.⁴ The program included predischarge and postdischarge pharmacist home visits.⁴ The study results showed that the program resulted in 67%, 28%, and 19% significant reductions, respectively, in adverse drug event–related hospital visits, emergency department visits, and hospital readmissions in the intervention group than in the usual care group.⁴

Another study evaluated a pilot model of care with pharmacists performing comprehensive medication reviews (CMRs) using an integrated team approach for home-based primary-care patients.² Investigators assessed 96 patients for medication-related problems. The patients, who had an average of 82 years, had an average of 13 chronic health conditions and were taking a median of 17 medications.² Approximately 81% of the patients received at least 1 medication recommendation; the pharmacists made a total of 175 medication recommendations and 53 (30.3%) were accepted.² The most common recommendations included deprescribing, dose adjustments, and medication discontinuation.² The most common potentially inappropriate medications were proton pump inhibitors (38.5%), aspirin (24%), tramadol (15.6%), benzodiazepines (13.5%), and opioids (8.3%).²

A study in Canada evaluated 100 patients from 6 community pharmacies that offered home MTM consults as part of their services.⁵ Ambulatory patients taking at least 5 medications for chronic health conditions who scored at least 3 points on a prescreening questionnaire for drug therapy problems were eligible to participate in the 15-month study.⁵ During home visits, pharmacists disposed of expired medications, evaluated drug storage, identified actual and potential medication-related problems, reviewed medication, and made recommendations for pharmacotherapy management.⁵

Pharmacists identified 275 drug therapy problems (an average of 2.75 per patient). The most common issues were additional therapy required (23.6%), nonadherence (23.3%), and adverse drug reactions (17.8%).⁵ Additionally, 32% of patients 65 years or older were taking at least 1 medication on the Beers Criteria list.⁵

About The Author

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times® contributor who lives in South Florida.

References

1. Ageing and health. World Health Organization. October 4, 2021. Accessed March 9, 2022. https://www.who.int/news-room/fact-sheets/ detail/ageing-and-health#:~:text=By%20 2050%2C%20the%20world%27s%20population,2050%20to%20reach%20426%20million

2. Monzón-Kenneke M, Chiang P, Yao NA, Greg M. Pharmacist medication review: an integrated team approach to serve home-based primary care patients. PLoS One. 2021;16(5):e0252151. doi:10.1371/journal.pone.0252151

3. Chapter 8 MTM models. The National Board of Medication Therapy Management. Accessed March 9, 2022. https://www.nbmtm.org/ mtm-reference/mtm-models/

4. Mekonnen A, McLachlan AJ, Brien JE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):e010003. doi:10.1136/bmjopen-2015-010003

5. Papastergiou J, Luen M, Tencaliuc S, Li W, van den Bemt B, Houle S. Medication management issues identified during home medication reviews for ambulatory community pharmacy patients. Can Pharm J (Ott). 2019;152(5):334-342. doi:10.1177/1715163519861420