Implementing a pharmacist-led in-home medication coaching service via community-based partnerships

Abstract

ObjectivesTo describe one independent pharmacy group’s experience delivering and being reimbursed for in-home medication coaching, or home visits, to high-risk and high-complexity community-dwelling patients. SettingA nondispensing clinical division of an independent community pharmacy in Seattle, Washington. Practice innovationA community pharmacist–led in-home medication coaching program delivered through partnerships with 3 community-based organizations for referrals and payment over a 4.5-year period. Community-based partners included a state comprehensive care management program, a local health system’s cardiology clinic, and the local Area Agency on Aging. EvaluationA retrospective analysis of patient demographics, drug therapy problems, interventions, and pharmacy and technician time was conducted with the use of the pharmacy’s internal patient care documentation and billing systems from January 1, 2012, to June 31, 2016. ResultsA total of 462 home visits (142 initial, 320 follow-up) were conducted with 142 patients. Patients averaged 13 disease states (range 3–31) and 16 medications (range 1–44) at their initial visit. Pharmacists identified an average of 11 drug therapy problems per patient (range 1–36) and performed an average of 13 interventions per patient (range 1–48). The most common drug therapy problem identified was nonadherence, and the most common intervention performed was education. The median pharmacist time in the home was 1.5 hours (range 0.67–2.75) for an initial visit and 1 hour (range 0.08–2.25) for a follow-up visit. ConclusionHome visits can be successfully implemented by community pharmacists to provide care to high-risk and high-complexity community-dwelling patients. Our experience may inform other community pharmacy organizations looking to develop similar home visit services.