Delivering domiciliary pharmaceutical care from a health centre pharmacy

Abstract

Abstract Aim To develop and administer a pharmacist domiciliary visiting programme from a community pharmacy based in a health centre. Design Prospective cohort with peer professional intervention assessment and patient feedback questionnaires. Subjects and setting Total general practitioner surgery list (4,922 patients) in an urban residential area. Candidates were defined by three inclusion criteria: 65 years or older taking five or more repeat medicines (polypharmacy); any age plus polypharmacy plus significant disablement; 80 years or older taking three or more specified medications on repeat prescription. Outcome measures Interventions made during a programme of three visits for each patient; peer assessment of impact on patient care and cost by the three surgery GPs and three clinical pharmacists; patients' perceived worth of the service; cost of the service. Results One hundred patients (2 per cent) were visited over a period of six months; 74 completed the three-visit programme that involved a total of 256 visits. There were 160 interventions classified as: medicines management issues (88), health beliefs and concordance (41) or therapeutic problems, including adverse effects (31). Nineteen patients required specific and detailed collaboration with the patient's GP. There was good agreement on the utility of the pharmacist's interventions at this level with only four negative assessments out of a possible 114 (3.5 per cent). The programme was well received by patients. Talking to a pharmacist (as opposed to another health care professional) about their medicines was important to 70 of 74 patients. Sixty-one described their reaction to the visiting programme using one of three positive adjectives, “relieved,” “reassured” or “grateful”. Based on this cohort, the estimated costs to the pharmacy were £5,000 per annum, equivalent to 33 working days. Cost savings based on outcomes were not estimated. Conclusions This study demonstrated the feasibility of identifying candidates for domiciliary care from surgery records using carefully selected inclusion criteria. This is likely to encompass between 2 and 3 per cent of a surgery population. The visiting programme, which was well received by patients, had a favourable effect on patient care in the majority of the cohort and a very important impact in a minority (19 per cent). This success required the commitment of all members of the health centre team. It benefited from the proximity of the visiting pharmacist to medical records and prescribers.