Pharmacists Making House Calls: RESULTS

In the first 2 years of the program (April 1, 2005, to March 31, 2007), 1171 patients received a home visit from a Medication Management Program pharmacist. The pharmacists made a total of 1736 visits to these clients, of which 1251 (72%) were home visits. On average, the home visits took 1.05 h each, and follow-up phone calls took 19 min each. The medication assessments done during these visits generated a total of 4346 recommendations to improve medication appropriateness, of which 3244 (74.6%) were accepted. The pharmacists provided other services as part of the visits: education (n = 1650 visits), cabinet-clearing (n = 400), recommending compliance aids (n = 502), requesting laboratory values (n = 269), and performing nonpharmacologic interventions (n = 777).

Of the 1171 patients, 202 were excluded from the analysis of resource utilization because they died within 1 year after receiving the home visit. A further 133 patients were excluded from the main analysis because the pharmacist visit was not related to a prior hospital stay; however, these patients were included in the additional analysis. Therefore, the main evaluation of resource utilization was based on 836 patients (71.4% of the cohort). Their median age was 80.3 years, and 503 (60.2%) were female.

Median resource utilization was significantly lower (by $11 014; p < 0.001) in the year after the home visit by a pharmacist than in the year before (Table 1). The breakdown of resource utilization into its components showed that there were fewer hospital admissions in the year after the home visit and shorter lengths of stay for those admissions that did occur. Medical Services Plan costs were also lower, but PharmaCare costs increased. canadian cialis

The median cost for the index hospital stay was $7000. Subtracting this amount from the median resource utilization in the year before the intervention reduced the difference in median resource utilization to $4014.

Table 1. Median 1-Year Resource Utilization Before and After Intervention (n = 836)

Variable

Before Intervention

After Intervention*

Difference (Before After)t


Median resource utilization


$16 685


$5 671


$11 014

p<0.001


Median length of hospital stay


12 days


0 days


12 days


Median no. of hospital admissions


1


0


1


Median cost of Medical Services Plan


$2 235


$1 824


$411


Median PharmaCare costs


$1 562


$2 138


-$576

The analysis of patients at the extremes of resource utilization showed that there was a reduction in median resource utilization for both groups (Table 2), but the reduction for the high resource utilization group (70th percentile or higher) was much greater. For both groups, PharmaCare expenditures increased after the intervention. Costs for the Medical Services Plan increased only for the group with low resource utilization (30 th percentile or below). cialis soft tablets

Table 2. Difference in Median Resource Utilization in Groups with Low and High Resource Utilization

Per-Client Difference in Resource Utilization,

* $

Group

Acute Medical Services Rehabilitationt Plan

PharmaCare

Median Overall*


Low resource utilization*
(n

= 251)


4 000 -203


-385


3 412
(p<0.001)


High resource utilization§
(n

= 251)


34 000 1536


-1077


34 459
(p<0.001)

Category: Main

Tags: home visit, pharmacist, resource utilization

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