Pharmacist medication review: An integrated team approach to serve home-based primary care patients.

<h4>Background</h4>Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a co...

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Autores principales:	Michele Monzón-Kenneke, Paul Chiang, Nengliang Aaron Yao, Mark Greg
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0d0274ff5e3d4c968cef3156e9033115
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spelling	oai:doaj.org-article:0d0274ff5e3d4c968cef3156e90331152021-12-02T20:05:32ZPharmacist medication review: An integrated team approach to serve home-based primary care patients.1932-620310.1371/journal.pone.0252151https://doaj.org/article/0d0274ff5e3d4c968cef3156e90331152021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252151https://doaj.org/toc/1932-6203<h4>Background</h4>Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a cohort of medically complex home-based primary care (HBPC) patients.<h4>Method</h4>Ninety-six medically complex patients were assessed for medication-related problems. Data collected on these patients were: number of chronic conditions, number of medications, appropriate indication for each medication, dose appropriateness, drug interactions, recommendations for medication optimization and deprescribing. The number of accepted recommendations by the HBPC practice was analyzed.<h4>Results</h4>On average, the patients were 82 years old and had 13 chronic conditions. They were taking a median of 17 medications. Over a four-month pilot period, 175 medication recommendations were made, and 53 (30.3%) of them were accepted, with most common being medication discontinuation, deprescribing, and dose adjustments. Sixty-four (66.7%) patients were on a medication listed as potentially inappropriate for use in older adults. The most common potentially inappropriate medication was a proton-pump inhibitor (38.5%), followed by aspirin (24%), tramadol (15.6%), a benzodiazepine (13.5%) or an opioid (8.3%). Eighty-one medications were recommended for deprescribing and 27 medications were discontinued (33.3%). There were 24 recommended dose adjustments and 11 medications were dose adjusted (45.8%). Thirty-four medications were suggested as an addition to the current patient regimen, 2 medications were added (5.9%).<h4>Conclusion</h4>Pharmacist comprehensive medication review is a necessary component of the HBPC healthcare continuum. Additional research is needed to examine whether aligning pharmacists to deliver support to HBPC improves clinical outcomes, reduces healthcare expenditures and improves the patient's experience.Michele Monzón-KennekePaul ChiangNengliang Aaron YaoMark GregPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0252151 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Michele Monzón-Kenneke Paul Chiang Nengliang Aaron Yao Mark Greg Pharmacist medication review: An integrated team approach to serve home-based primary care patients.
description	<h4>Background</h4>Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a cohort of medically complex home-based primary care (HBPC) patients.<h4>Method</h4>Ninety-six medically complex patients were assessed for medication-related problems. Data collected on these patients were: number of chronic conditions, number of medications, appropriate indication for each medication, dose appropriateness, drug interactions, recommendations for medication optimization and deprescribing. The number of accepted recommendations by the HBPC practice was analyzed.<h4>Results</h4>On average, the patients were 82 years old and had 13 chronic conditions. They were taking a median of 17 medications. Over a four-month pilot period, 175 medication recommendations were made, and 53 (30.3%) of them were accepted, with most common being medication discontinuation, deprescribing, and dose adjustments. Sixty-four (66.7%) patients were on a medication listed as potentially inappropriate for use in older adults. The most common potentially inappropriate medication was a proton-pump inhibitor (38.5%), followed by aspirin (24%), tramadol (15.6%), a benzodiazepine (13.5%) or an opioid (8.3%). Eighty-one medications were recommended for deprescribing and 27 medications were discontinued (33.3%). There were 24 recommended dose adjustments and 11 medications were dose adjusted (45.8%). Thirty-four medications were suggested as an addition to the current patient regimen, 2 medications were added (5.9%).<h4>Conclusion</h4>Pharmacist comprehensive medication review is a necessary component of the HBPC healthcare continuum. Additional research is needed to examine whether aligning pharmacists to deliver support to HBPC improves clinical outcomes, reduces healthcare expenditures and improves the patient's experience.
format	article
author	Michele Monzón-Kenneke Paul Chiang Nengliang Aaron Yao Mark Greg
author_facet	Michele Monzón-Kenneke Paul Chiang Nengliang Aaron Yao Mark Greg
author_sort	Michele Monzón-Kenneke
title	Pharmacist medication review: An integrated team approach to serve home-based primary care patients.
title_short	Pharmacist medication review: An integrated team approach to serve home-based primary care patients.
title_full	Pharmacist medication review: An integrated team approach to serve home-based primary care patients.
title_fullStr	Pharmacist medication review: An integrated team approach to serve home-based primary care patients.
title_full_unstemmed	Pharmacist medication review: An integrated team approach to serve home-based primary care patients.
title_sort	pharmacist medication review: an integrated team approach to serve home-based primary care patients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/0d0274ff5e3d4c968cef3156e9033115
work_keys_str_mv	AT michelemonzonkenneke pharmacistmedicationreviewanintegratedteamapproachtoservehomebasedprimarycarepatients AT paulchiang pharmacistmedicationreviewanintegratedteamapproachtoservehomebasedprimarycarepatients AT nengliangaaronyao pharmacistmedicationreviewanintegratedteamapproachtoservehomebasedprimarycarepatients AT markgreg pharmacistmedicationreviewanintegratedteamapproachtoservehomebasedprimarycarepatients
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Pharmacist medication review: An integrated team approach to serve home-based primary care patients.

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