As medication experts, pharmacists can have a huge impact on improving medication safety, engaging patients in medication self-management and reducing ADEs. They play an integral role on the healthcare team for patients in the homecare setting.
The University of Rhode Island (URI) College of Pharmacy implemented an innovative practice model, where sixth year student pharmacists were assigned to a rotation, in conjunction with participating Visiting Nurse Agencies (VNAs) in Rhode Island. Student pharmacists spent three days per week traveling with a nurse or physical therapist to patients’ homes, under the supervision of a community or hospital pharmacist. In the home, students provided services that ranged from patient and VNA staff education, and medication reconciliation.
Students documented their findings in a data collection tool developed by the New England QIN-QIO. This tool tracked a variety of data, including number of patient visits, medication reconciliations, medication related discrepancies by type, and cost avoidance. URI sent the data to a New England QIN-QIO analyst, who produced a summary report at the end of each semester.
Over the course of two years, students visited 1,787 homes, and provided medication reconciliation to 1,555 patients. Data from the home visits showed medication adherence as the highest incidence of medication discrepancy; pharmacists provided 363 cases of adherence support. In addition, their services prevented 186 physician visits and 46 hospital admissions.
When medication discrepancies occur, pharmacists can identify and provide valuable recommendations to a prescriber. Data shows that 46% of the total recommendations were accepted by the physician. This percentage grew from 33.6% in Spring 2014, to 77.4% in Spring 2016.
Currently, there is not a reimbursement mechanism in place for pharmacists, so there are challenges with implementing or continuing programs such as the one at URI. It is hoped that the collection of this data will help to validate the return on investment the healthcare system would receive by using pharmacists to help patients review and manage their medications at home.