Evaluation of pharmacist involvement in multidisciplinary home visits in a primary care–based management services organization

Abstract

BackgroundHealth care delivery has shifted from fee-for-service to value-based models, allowing pharmacists to integrate within value-based organizations to improve patient outcomes. Although previous studies describe pharmacist involvement in value-based office settings, limited knowledge exists on pharmacist integration in multidisciplinary home visits in a value-based setting. ObjectivesThis study aimed to describe the integration of pharmacists into multidisciplinary chronic care management (CCM) home visits involving paramedics within a primary care–focused value-based setting. The primary objective is to identify the types and frequency of medication-related problems (MRPs) identified by pharmacists during home visits. The secondary objectives are to determine the number and types of recommendations made to and accepted by providers and patient satisfaction with the pharmacist during the home visit. MethodsPrimus Health, a primary care–focused management services organization, integrated pharmacists in CCM home visits. Two ambulatory care pharmacy residents and one clinical pharmacist conducted home visits from January to May 2023 to complete medication reconciliation, identify MRPs, and provide pharmacy support services for patients and providers. A password-protected database was built for data collection and analysis. The data are presented in aggregate. ResultsTwenty-one visits involving 15 patients were conducted and 77 MRPs were identified. The most common MRPs were nonadherence (11.6%), laboratory monitoring needed (11.6%), and overdue vaccination (11.6%). Twenty-three of 36 recommendations (63.9%) made to providers were accepted, leading to a therapeutic change. Commonly accepted recommendations were decreasing dose (21.7%), medication deprescription (21.7%), and ordering of laboratory tests (21.7%). All patients agreed or strongly agreed that they were satisfied with the pharmacist-provided care during the home visit. ConclusionsIntegration of pharmacists into multidisciplinary CCM home visits led to the resolution of MRPs and demonstrated a potential need for enhanced clinical pharmacy services for home care patients in primary care–focused value-based settings.