By Jasmine Gill
In Canada, the rising costs of delivering tertiary care health services and an aging population have prompted a shift towards optimizing primary care and outpatient-based services. Pharmacists have traditionally played a large role in providing care in community pharmacy practices. Today, pharmacists are increasingly expanding and innovating practices in other outpatient settings, including the home.
Given that many older adults in Canada would like to remain in their own homes for as long as they can, home-based care is a desirable and convenient option for many patients. Patients who utilize home care services are often seniors with multiple medical conditions and complex medication regimens, placing them at risk of adverse medication-related events. Thus, pharmacists serve a vital role in optimizing medication therapy for these patients. With a continuously expanding scope of practice, pharmacists can provide a wide array of outpatient clinical services. In Alberta, for instance, pharmacists are able to administer drugs by injection, prescribe medications, and order laboratory tests. Home care pharmacists in Alberta are therefore uniquely positioned to extensively address concerns about multiple medications and other health issues.
While there are various iterations of in-home pharmacy services that have been described in the literature, there is limited information about the role of pharmacists working as part of interdisciplinary home care teams. Thus, our research team sought to describe the type of clinical activities performed by home care pharmacists in Edmonton, Alberta over a one-year timeframe. Determining the utilization and scope of clinical services provided by home care pharmacists may help direct practice and maximize benefits to patients.
To provide context, the Edmonton Zone home care program has integrated pharmacy services into the program for over two decades. Along with other allied healthcare professionals, pharmacists provide consultative services and receive referrals from case managers for medication-related concerns. As consultants, home care pharmacists in the Edmonton Zone commonly collaborate with other home care health professionals in order to make recommendations and initiate services to manage medication therapy.
Based on data from initial consultations and home visits, our study’s results showed that pharmacists provided a variety of clinical services, including ordering lab tests, prescribing and deprescribing medications, and facilitating seamless care as patients transitioned between inpatient to outpatient settings. Additionally, pharmacists were heavily involved in providing patient education, collaborating with other healthcare professionals, and arranging referrals to other consultants when needed. Particularly of note was our data showing that home care pharmacists played a greater role in optimizing therapy for older patients, female patients, and patients taking multiple medications.
Engaging with the patient in their home enables pharmacists to assess the patient’s use of compliance aids and evaluate how their medication is stored. In the patient’s home, pharmacists can help prevent medication errors by identifying unlabeled products and packing expired or unused medications for disposal. Moreover, home care pharmacists serve a critical role as liaisons at transitions of care between hospital and community settings. For patients recently discharged from the hospital, home care pharmacists can reinforce medication teaching, evaluate changes to medication therapy in the context of the patient’s clinical condition at home, and identify if there is a need for compliance packaging, which can be arranged in collaboration with the patient’s community pharmacist. Home care pharmacists are also involved in ordering in-home lab collections, which facilitate timely monitoring of medication therapy for patients who may be home-bound or otherwise unable to access laboratory services.
The results of our study underscore the broad range of clinical services provided by home care pharmacists, particularly for older patients and those taking multiple medications. The results also illustrate pharmacists’ substantial role in addressing the ongoing need for patient education. Home care pharmacists bring valuable expertise to the interdisciplinary health care team. Integration into home care teams allows pharmacists to be involved in the care of medically complex patients who would benefit from evaluation of their medication therapies. Furthermore, connections to multiple home health care professionals facilitates collaborative care and ensures patients have access to appropriate services.
Optimizing the care of community-dwelling patients has been recognized as an approach to mitigate unnecessary hospital admissions and healthcare costs. In light of the COVID-19 pandemic, the role of home care services and home pharmacy services will likely continue to evolve in the future. We hope that more regions will consider this innovative model of care, with pharmacists integrated into the home care team.
Jasmine Gill is a Pharmacist at Alberta Health Services in Edmonton, Alberta, and a class of 2024 medical student in the University of Alberta Faculty of Medicine and Dentistry.