Studies
Randomized Controlled Trial of the Effectiveness and Efficiency of a Pharmacotherapy Consultative Service for Providers and Clients of In-Home Health Care
Author: Willison D, Browne G, Hutchison B, Levine M, Gafni A
Intervention Type: Patient-Mediated Interventions, Educational Outreach Visits to Patients, Revision of Professional Roles
Disease State: Not specific to any chronic disease
Research Objective
To evaluate a model of augmenting the supervision of medication use among clients receiving in-home care services
Methods
Design: Randomized controlled trial that was 18 months duration
Study sample: General practitioners; Pharmacist; Community-dwelling adults
Intervention:
Group 1-Intervention: Patients received in-home medication assessment by a pharmacist if they were using four or more medications or if they had one of five targeted disease states (asthma, COPD, coronary artery disease, congestive heart failure and diabetes) recommendations were communicated to the family physicians. Written letters to the family physician were provided when a medications addition, deletion or substitution was recommended in order to provide the family physician with an accurate summary of the client’s drug information for future reference, or to update the physician on the client’s progress.
The visiting nurse was contacted before the initial home visit was arranged with the client. In addition, any issues identified by the pharmacist in the course of a home visit were documented in the visiting nurses’ chart, which was left in the client’s home.
Group 1-Control: Usual care
Medication Prescribing and Use Outcome(s)
- Nurse-reported and self-reported number of drugs used
Other Outcome(s)
- (Re-)hospitalizations
- Nursing visits
- Drug costs
- Medical services
Key Results (Note: Authors’ level of significance: p<0.05)
- No significant difference between groups in nurse- or self-reported number of drugs used
- Trend towards more of the intervention group patients having at least one hospitalization over the 3 months compared to the control (35% versus 27%; OR 1.4-1.6)
- There were no differences were observed in: any use of the Emergency Department or total Emergency Department visits
- There was a trend toward reduced numbers of nursing and increased visits to the family physician visits in the intervention group
- No significant difference between groups in the costs of drugs and medical services
Key Implementation Issues
- There were changes in the home care “market” approximately one-third of the way into the study. The budgetary reduction on the part of provider agencies made it difficult for front-line visiting nurses to follow through on recommendations of the pharmacist as originally planned.
- Limited contact with the prescribing physician
Citation(s)
Randomized Controlled Trial of the Effectiveness and Efficiency of a Pharmacotherapy Consultative Service for Providers and Clients of In-Home Health Care. Willison, D., Browne, G., Hutchison, B., Levine, M., & Gafni, A. (2002). Unpublished Report.