Spending on medications in Canada continues to rise dramatically. The Canadian Institute for Health Information has estimated that 16.8% of total Canadian expenditures on health care in 2007 was spent on medications, a proportion that is second only to spending on hospitals. Hence, it is imperative that medications be used effectively and appropriately.
Tweedie and Jones defined medicines or medication management as “the systematic provision of medicines therapy through a partnership of effort between patients and professionals to deliver best patient outcome at minimized cost.” This definition encompasses the provision of pharmaceutical care and is operationalized by a pharmacist providing clinical services across care settings. A recent survey of clinical pharmacy services in Canadian hospital settings suggested that there had been an increase in the provision of inpatient and outpatient clinical pharmacy services. However, one care situation not mentioned in that report is the provision of clinical pharmacy services at home to those recently discharged from acute care services. Problems with medication therapy can occur during the transition between hospital and home. The reported incidence rate for adverse drug events after hospital discharge ranges from 11% to 20%, and these events can result in further use of acute care resources. As such, medication management services in the home are needed after hospital discharge to prevent adverse drug events and avoid unnecessary use of acute care resources.
Although the provision of clinical pharmacy services is relatively new in home care, there is increasing evidence to support the role and benefit of such services in this setting. Several reports have documented the provision of home care pharmacy services in supporting patients after discharge from acute care. The High-Risk Patient Intervention Program (HRPIP), a randomized controlled trial conducted in 1999 and 2000, showed that a postdischarge visit from a pharmacist and nurse to elderly patients significantly reduced the number and duration of subsequent hospital stays (McGowan P, Green L, Beattie BL, Chappell N, Clarke H, Gayton D, et al. High-risk patient intervention program. Summary of evaluation results. Vancouver [BC]: University of British Columbia, Institute of Health Promotion Research; 2001. Unpublished). Other literature has corroborated the benefit of a home visit by a pharmacist after hospital discharge on patient outcomes such as unplanned readmissions, out-of-hospital deaths, visits to the emergency department, days in hospital, and bleeding events (for those discharged on warfarin). levitra 10 mg
In response to this evidence, the Fraser Health Authority initiated its Medication Management Program in 2005, modelling the new program on the HRPIP. The program, which targets elderly patients (65 years of age or older) who are taking at least 6 regular medications at the time of discharge from hospital, involves pharmacists visiting the patients at home within a week of discharge. In addition, the program’s pharmacists receive referrals from health care practitioners to see other home-based patients.
In contrast to the evidence illustrating the benefit of clinical pharmacy services in the home, as summarized above, several authors have reported either no benefit or increased utilization of health service resources by patients who have received home pharmacy care after discharge. Given the equivocal nature of the evidence relating to clinical pharmacy services in the home after discharge, formal evaluations of such initiatives will help to determine the circumstances in which they are effective. canadian discount pharmacy
The purpose of this study was to evaluate the effectiveness of the Medication Management Program in reducing subsequent utilization of health service resources among those who received the intervention.