Development and implementation of a postdischarge home-based medication management service

Emily C. Pherson, Kenneth M Shermock, Leigh E. Efird, Vi T. Gilmore, Todd Nesbit, Yvonne Leblanc, Daniel Brotman, Amy Deutschendorf, Meghan Davlin Swarthout

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1576-1583
Number of pages8
JournalAmerican Journal of Health-System Pharmacy
Volume71
Issue number18
DOIs
StatePublished - Sep 15 2014

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Pharmacists
Primary Health Care
Pharmacies
Patient Education
Patient Care
Medication Reconciliation
Patient Transfer
Continuity of Patient Care
Administrative Personnel
Prescriptions
Life Style
Nursing
Demography
Physicians

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy
  • Medicine(all)

Cite this

Pherson, E. C., Shermock, K. M., Efird, L. E., Gilmore, V. T., Nesbit, T., Leblanc, Y., ... Swarthout, M. D. (2014). Development and implementation of a postdischarge home-based medication management service. American Journal of Health-System Pharmacy, 71(18), 1576-1583. https://doi.org/10.2146/ajhp130764

Development and implementation of a postdischarge home-based medication management service. / Pherson, Emily C.; Shermock, Kenneth M; Efird, Leigh E.; Gilmore, Vi T.; Nesbit, Todd; Leblanc, Yvonne; Brotman, Daniel; Deutschendorf, Amy; Swarthout, Meghan Davlin.

In: American Journal of Health-System Pharmacy, Vol. 71, No. 18, 15.09.2014, p. 1576-1583.

Research output: Contribution to journalArticle

Pherson, EC, Shermock, KM, Efird, LE, Gilmore, VT, Nesbit, T, Leblanc, Y, Brotman, D, Deutschendorf, A & Swarthout, MD 2014, 'Development and implementation of a postdischarge home-based medication management service', American Journal of Health-System Pharmacy, vol. 71, no. 18, pp. 1576-1583. https://doi.org/10.2146/ajhp130764
Pherson, Emily C. ; Shermock, Kenneth M ; Efird, Leigh E. ; Gilmore, Vi T. ; Nesbit, Todd ; Leblanc, Yvonne ; Brotman, Daniel ; Deutschendorf, Amy ; Swarthout, Meghan Davlin. / Development and implementation of a postdischarge home-based medication management service. In: American Journal of Health-System Pharmacy. 2014 ; Vol. 71, No. 18. pp. 1576-1583.
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