Community Based Care: Integrating Pharmacy Services

Background: A limited number of studies to date have demonstrated patient benefits of incorporating pharmacists within a community based medical care program. In addition, pharmacy student involvement in such programs has not been adequately studied. Providing medical care in the community and homes of patients is an ACGME educational mandate for family medicine residency training. This mandate ensures primary care physicians receive training in the health of communities. Multidisciplinary care teams are often the norm, however few include a role for pharmacists in community health.

Objective: To determine the impact of pharmacist and pharmacy student services in a family medicine residency community based medical care program.

Methods: Community based care team members for the University of Pennsylvania Family Medicine Residency include: an attending and resident physician, a social worker, a pharmacist and/or pharmacy student. Patients are assessed in their home environment and the team engages in collaborative decision making with the patient around medications, long term care options, and the influence of environment on chronic illness. The pharmacist evaluates medication taking habits in the home and conducts medication reconciliation including OTC/herbals. Adherence and medication use counseling are provided. Data on visit reason, interventions, follow-up, adverse events and medication related problems was analyzed for trends.

Results: Of the 45 patients visited by the care team, 63 medication related problems (mean 1.4 problems/patient) were identified by the pharmacist/pharmacy student. Of those, 51% were due to adherence issues, 29% of patients had experienced an adverse drug event, 4% had a drug interaction requiring a change in therapy, and 16% were categorized as other. Medication adverse events identified included: overuse, under-use, taking a medication that was stopped, expired medications, duplicate therapy, low health literacy, incorrect administration. Solutions were developed for all identified drug related problems and adverse events at the point of care in the patient's home. Additional interventions included home delivery set up, switching to lower cost alternatives, and device assessment and education. All community participants were given a patient-specific medication administration chart.

Conclusion: Incorporating a pharmacist and pharmacy students within community based care teams can help identify and reduce medication related problems and supplement physician provided care. While many home care teams are multidisciplinary in nature, far fewer include a pharmacist as a team member. The findings from this study reveal the key role pharmacists play in community based medical care.