TY - JOUR
T1 - Development and implementation of a postdischarge home-based medication management service
AU - Pherson, Emily C.
AU - Shermock, Kenneth M.
AU - Efird, Leigh E.
AU - Gilmore, Vi T.
AU - Nesbit, Todd
AU - Leblanc, Yvonne
AU - Brotman, Daniel J.
AU - Deutschendorf, Amy
AU - Swarthout, Meghan Davlin
N1 - Publisher Copyright:
Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved.
PY - 2014/9/15
Y1 - 2014/9/15
N2 - Purpose. The development and implementation of a postdischarge home-based, pharmacist-provided medication management service are described. Summary. A work group composed of pharmacy administrators, clinical specialists, physicians, and nursing leadership developed the structure and training requirements to implement the service. Eligible patients were identified during their hospital admission by acute care pharmacists and consented for study participation. Pharmacists and pharmacy residents visited the patient at home after discharge and conducted medication reconciliation, provided patient education, and completed a comprehensive medication review. Recommendations for medication optimization were communicated to the patient's primary care provider, and a reconciled medication list was faxed to the patient's community pharmacy. Demographic and medication-related data were collected to characterize patients receiving the home-based service. A total of 50 patients were seen by pharmacists in the home. Patient education provided by the home-based pharmacists included monitoring instructions, adherence reinforcement, therapeutic lifestyle changes, administration instructions, and medication disposal instructions. Pharmacists provided the following recommendations to providers to optimize medication regimens: adjust dosage, suggest laboratory tests, add medication, discontinue medication, need prescription for refills, and change product formulation. Pharmacists identified a median of two medication discrepancies per patient and made a median of two recommendations for medication optimization to patients' primary care providers. Conclusion. The implementation of a post-discharge, pharmacist-provided home-based medication management service enhanced the continuity of patient care during the transition from hospital to home. Pharmacists identified and resolved medication discrepancies, educated patients about their medications, and provided primary care providers and community pharmacies with a complete and reconciled medication list.
AB - Purpose. The development and implementation of a postdischarge home-based, pharmacist-provided medication management service are described. Summary. A work group composed of pharmacy administrators, clinical specialists, physicians, and nursing leadership developed the structure and training requirements to implement the service. Eligible patients were identified during their hospital admission by acute care pharmacists and consented for study participation. Pharmacists and pharmacy residents visited the patient at home after discharge and conducted medication reconciliation, provided patient education, and completed a comprehensive medication review. Recommendations for medication optimization were communicated to the patient's primary care provider, and a reconciled medication list was faxed to the patient's community pharmacy. Demographic and medication-related data were collected to characterize patients receiving the home-based service. A total of 50 patients were seen by pharmacists in the home. Patient education provided by the home-based pharmacists included monitoring instructions, adherence reinforcement, therapeutic lifestyle changes, administration instructions, and medication disposal instructions. Pharmacists provided the following recommendations to providers to optimize medication regimens: adjust dosage, suggest laboratory tests, add medication, discontinue medication, need prescription for refills, and change product formulation. Pharmacists identified a median of two medication discrepancies per patient and made a median of two recommendations for medication optimization to patients' primary care providers. Conclusion. The implementation of a post-discharge, pharmacist-provided home-based medication management service enhanced the continuity of patient care during the transition from hospital to home. Pharmacists identified and resolved medication discrepancies, educated patients about their medications, and provided primary care providers and community pharmacies with a complete and reconciled medication list.
UR - http://www.scopus.com/inward/record.url?scp=84907226120&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907226120&partnerID=8YFLogxK
U2 - 10.2146/ajhp130764
DO - 10.2146/ajhp130764
M3 - Article
C2 - 25174018
AN - SCOPUS:84907226120
SN - 1079-2082
VL - 71
SP - 1576
EP - 1583
JO - American Journal of Health-System Pharmacy
JF - American Journal of Health-System Pharmacy
IS - 18
ER -