Home care pharmacy: Extending clinical pharmacy services beyond infusion therapy

A clinical pharmacy program was developed at an established home health car e (HHC) agency to demonstrate the need for clinical pharmacy services in th e HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies. Initial experiences of this pilot p roject are described. Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred t o the agency required infusion therapy, multiple opportunities for pharmaci st involvement in patient care were identified and a variety of projects we re undertaken. A drug information service was developed, a retrospective ev aluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitorin g was assessed, pharmaceutical care services were provided to patients enro lled in a long-term home care program, a pain management initiative was beg un. adverse drug rt actions were identified and reported, and pharmacists p articipated in agency policy development. Preliminary data suggest that pha rmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recomm endations of which 33% were accepted. Pharmacists working with a home care agency identified numerous opportuniti es for improving patient care. Many of the patients receiving home care ser vices were elderly, took a substantial number of medications, and were at r isk for drug-related problems and suboptimal therapy.