Home Care Pharmacy Research Articles

Adherence and clinical outcomes of hypertensive patients in rural areas after receiving home pharmacy care interventions

Adherence is still a significant problem in the treatment of hypertension, so appropriate interventions are needed to overcome this condition. This study aims to determine the effect of home pharmacy care on medication adherence and clinical outcomes. This research is a pilot study using a quasi-experimental pre- and post-design with control in primary health care facilities in rural areas involving 40 hypertensive patients divided into two each 20 patients in the control and treatment groups. The MGLS questionnaire measured treatment adherence and clinical outcome by assessing blood pressure. Data were analyzed using descriptive statistics, bivariate tests using chi-square, Mann Whitney, paired t-test, and Wilcoxon signed ranks-test. At the beginning and end of the study there was no difference in the level of treatment adherence in the control group (p=0.701) while in the intervention group there was a significant difference (p=0.009). Systolic blood pressure in the control group (p=0.000) and the intervention group (p=0.004) showed a difference, while there was no difference in diastolic blood pressure in the two groups. In addition, there was no difference in achieving blood pressure targets between groups (p=0.522). The findings in this study are that home pharmacy services have the potential to increase medication adherence in rural areas but have not had an impact on reducing pressure and achieving targets.

THE EFFECT OF HOME PHARMACY CARE EDUCATION ON BLOOD PRESSURE CONTROL AND KNOWLEDGE LEVEL OF HYPERTENSIVE PATIENTS AT KENDALSARI PUBLIC HELATH CENTRE MALANG

Hypertension is one of the ten most common degenerative diseases and has a high mortality rate. In 2020, the prevalence of hypertension in Malang City reached 35,641 cases. The role of pharmacists as caregivers in home pharmacy care can help to control hypertension and reduce morbidity. The main objective of this study was to determine the effect of home pharmacy care on hypertension patients’ knowledge and blood pressure management. This study used a quantitative experimental design with a Randomized Control Trial method, with a total of 34 respondents divided into 2 groups: the control group and the test group of 17 respondents each. Using an accidental sampling technique. The research location was Kendalsari Public Health Centre Malang in August 2023. Blood pressure data were measured using a tensimeter, and knowledge level data were obtained using a knowledge questionnaire. Data analysis was performed using paired and pooled t-tests. The results of the analysis of the effect of home pharmacy care on the level of patient knowledge about hypertension with a significance value (2tailed) p = 0.000, and analysis of the effect of home pharmacy care on systolic and diastolic blood pressure with a significance value (2tailed) p = 0.030. The results of this study concluded that home pharmacy care for hypertensive patients had a positive effect on blood pressure control and increased knowledge at the Kendalsari Public Health Center, Malang. Keywords: Home pharmacy care, hypertension, blood pressure control, knowledge level.

Home Pharmacy Care Penyakit Tidak Menular di Samarinda

Home pharmacy care on non-contagious patients is necessary to increase the quality of therapeutic outcome. This program was done in a district in Samarinda. Participant selection was done by participating of nearest primary health facility. Permissions were given from the district and the nearest health facility. Three visitations were done for determination, education, and evaluation steps. The personal education during this program shows a positive impact on the own responsibility of self adherence under drug regimen. Generally, medical examination on blood pressure, blood glucose, and others are better after effective education of this program. Education output of this program is useful to increase patient’s adherence to drug regimen and healthy lifestyle.

COST ANALYSIS OF HOME PHARMACY CARE PROGRAM AMONG DIABETES PATIENTS IN PHARMACY

Background: Home pharmacy care is expected to be able to provide a pharmaceutical service that not only reduces the incidence of drug interactions and side effects but also increases the effectiveness of therapy and patient compliance in using drugs. Aims: The study aimed to analyze the costs incurred for the home pharmacy care program for diabetic patients at the pharmacy. Methods: This analysis used the independent variable by providing a program of home pharmacy care. The dependent variable was the cost of running the program of home pharmacy care. The sample was the pharmacist in charge of the pharmacies in the Banyumas and Cilacap districts, which provide a home pharmacy care service program. The sample was conducted by purposive sampling method. Sampling was done by direct interviews with pharmacists who signed informed consent. Break Even Point (BEP) was calculated to determine the number of patients who must be served. The pharmacoeconomic analysis used is Cost Analysis using the activity-based costing (ABC) method. Results: The lowest rate for home pharmacy care services is Rp. 17,000, and the highest is Rp.31,000 without including home pharmacy care services. Conclusions: Pharmacies continue to benefit from the home pharmacy care program, and there is no provision for home pharmacy care service rates. Keywords: Activity Based Costing (ABC), Diabetes Mellitus, Home pharmacy care (HPC)

COST ANALYSIS OF HOME PHARMACY CARE PROGRAM AMONG DIABETES PATIENTS IN PHARMACY

Background: Home pharmacy care is expected to be able to provide a pharmaceutical service that not only reduces the incidence of drug interactions and side effects but also increases the effectiveness of therapy and patient compliance in using drugs. Aims: The study aimed to analyze the costs incurred for the home pharmacy care program for diabetic patients at the pharmacy. Methods: This analysis used the independent variable by providing a program of home pharmacy care. The dependent variable was the cost of running the program of home pharmacy care. The sample was the pharmacist in charge of the pharmacies in the Banyumas and Cilacap districts, which provide a home pharmacy care service program. The sample was conducted by purposive sampling method. Sampling was done by direct interviews with pharmacists who signed informed consent. Break Even Point (BEP) was calculated to determine the number of patients who must be served. The pharmacoeconomic analysis used is Cost Analysis using the activity-based costing (ABC) method. Results: The lowest rate for home pharmacy care services is Rp. 17,000, and the highest is Rp.31,000 without including home pharmacy care services. Conclusions: Pharmacies continue to benefit from the home pharmacy care program, and there is no provision for home pharmacy care service rates. Keywords: Activity Based Costing (ABC), Diabetes Mellitus, Home pharmacy care (HPC)

Attitudes and Perceptions of Pharmacists About Home care pharmacy services in Saudi Arabia

Attitudes and Perceptions of Pharmacists About Home care pharmacy services in Saudi Arabia

Home medication management problems and associated factors among psychiatric patients using home care pharmacy services at government hospitals in western Malaysia

BackgroundProper home medication management plays a role in improving medication adherence, preserving drug efficacy and ensuring safe medication practices, which is crucial to establish positive treatment outcomes. However, no published studies are available on home medication management among psychiatric patients. The study aimed to identify home medication management problems among psychiatric patients in Malaysia and to examine the associations of inappropriate medication storage and lack of a medication administration schedule with sociodemographic factors, disease insight, number of medications and type of home care pharmacy services (HCPS).MethodsThis multicentre cross-sectional study was conducted among psychiatric patients using HCPS in six government hospitals in western Malaysia. Data were extracted from the HCPS form used for each visit as per the protocol published by the Pharmaceutical Services Division, Ministry of Health Malaysia. A minimum sample size of 169 was needed. Proportional random sampling was applied. The associations of inappropriate medication storage and lack of medication administration schedule with study parameters were analysed using multiple logistic regressions.ResultsA total of 205 home visits were conducted with 229 home medication management problems identified; inappropriate medication storage and lack of medication administration schedule topped the list. Inappropriate medication storage was significantly associated with low income [AOR = 4.34 (95% CI 1.17:15.98), p = 0.027], alcohol consumption [AOR = 14.26 (95% CI 1.82:111.38), p = 0.011], poor insight [AOR = 2.34 (95% CI 1.08:5.06), p = 0.030] and part-time HCPS [AOR = 2.60 (95% CI 1.20:5.67), p = 0.016]. Lack of administration schedule was significantly associated with low income [AOR = 6.90 (95% CI 1.46:32.48), p = 0.014], smoking [AOR = 2.43 (95% CI 1.20:4.92), p = 0.013], poor insight [AOR = 5.32 (95% CI 2.45:11.56), p < 0.05] and part-time HCPS [AOR = 2.96 (95% CI 1.42:6.15), p = 0.004].ConclusionsInappropriate medication storage and a lack of a medication administration schedule are common among psychiatric patients. The study also highlighted the potential of HCPS to improve disease insight and home medication management among psychiatric patients if the service is utilized fully.

Profile of Therapy Adherence-Prolanis Related to Sociodemography: A Literature Review

The results of this literature review present a profile of measuring adherence to therapy in prolanis member. More specifically, the authors explored the adherence related to the sociodemographic variants. The literature search utilizes the Google Scholar data storage base. Researchers used two variants of keywords; (1) “prolanis” and “drug”, (2) “prolanis” and “pharmaceutical”. The literature search is limited to the results of publications during the years 2010-2020. Literature review studies only involve research results that meet the following inclusion criteria; (1) scientific articles published after going through the peer review process, (2) research involving sociodemographic variables and therapy adherence index, (3) research involving only prolanis participants, and (4) research results showing correlation values between variables. A total of 9 articles met the inclusion criteria according to the research objectives. This literature review involved 644 respondents from 12 health centers and 1 treatment center as subjects in this study. The results of our literature review confirm that prolanis participants need family support and adequate knowledge, in order to adhere to therapy. In addition, we also conclude that there is no relationship between gender differences and adherence to therapy. Based on these conclusions, we recommend community pharmacy practitioners, to optimize educational services and provide basic information about drugs, both to prolanis participants and their families. We note that researchers have not mutually agreed on the relationship between therapy adherence with age, education, type of work and home pharmacy care services in prolanis. The exploration of sociodemographic variables, which is still a matter of debate, is a priority for further research to identify adherence to prolanis therapy. We also suggest to future researchers to avoid the use of MMAS-8. The use of questionnaires without permission from the inventor is prone to licensing problems.

Providing counseling through home pharmacy care (HPC) for hemodialysis patients with hypertension in lowering blood pressure.

Hypertension is one of the main factors in increasing the risk of cardiovascular disease with 51% reported cause of death in chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). It is a comorbid that needs to be managed properly and gets special attention from various health disciplines including a pharmacist. This was a quasi experimental study with pretest-posttest intervention using home pharmacy care (HPC) counseling both on the counseling and the noncounseling group. Initial data collection and informed consent was done at the Hemodialysis Unit Aloei Saboe and Toto Kabila Hospital, Gorontalo. The parameters in the study were patients' compliance to their medication using the Medication Adherence Questionnaire (MAQ) and Pill Count Adherence (PCA) questionnaires and the patient's blood pressure. Fifty-eight patients met the inclusion criteria and were divided into two groups (the counseling group and the noncounseling group). Based on MAQ and PCA, the level of patient medication adherence increased significantly in the counseling group compared to the noncounseling group with a significance value of p<0.05. Increasing adherence was correlated with patients' outcome of lowering blood pressure. More patients in the counseling group showed decrease in systolic and diastolic blood pressure compared to the noncounseling group (86.2 vs. 17.2% for systolic BP and 69 vs. 10.3% for diastolic blood pressure (BP). Following adjusted confounding variables, counseling through HPC provided a chance of decreasing systolic blood pressure 32 times (95% CI: 7.198-144.550) and diastolic blood pressure 42 times (95% CI: 6.204-286.677). HPC affects the improvement of patient medication adherence and reduction of blood pressure in hemodialysis patients with hypertension.

Faktor-Faktor Yang Berpengaruh Terhadap Perilaku Pengelolaan Dagusibu Obat Pada Masyarakat dengan Home Pharmacy Care di Wilayah Kecamatan Jakarta Pusat

&#x0D; The household drug management is common practice worldwide especially Ethical drugs and OTC Drugs that indicated are acute and chronic condition. The beside higher costs, accumulation medicines at home can be attributed to the lack of knowledge and behavior in patient, patient's family and environmental. Negative relationships in household drug management more likely risk for elderly people have many illnesses and polypharmacy, drug interactions and adverse drug reactions. The objective of this study to analyze the factors Associated to behavior Dagusibu drug management in Community Jakarta Pusat With Home Pharmacy Care. This research used observational research by using cross-sectional design. this research type probability sampling with technique is cluster random sampling. The data analysis used bivariate analysis , especially chisquare test. The result of multivariate analysis showed the variable were significantly related to behavior dagusibu drug management, namely variables were medicine dispossal box (p=0.019;OR 3.009); medicine safety box (p=0.025;OR 2.974) and influence efect of family support (p=0.001;OR=5.092).

LEGAL PROTECTION OF PHARMACY TAKES A PHARMACY CARE IN THE EVENT OF EMERGENCY

The legal protection of pharmacists is very important, because if there is no legal protection in carrying out pharmaceutical practices by a pharmacist it will become an obstacle in the running of pharmaceutical services to the public, especially with the new concept of pharmacy services at home (home pharmacy care). The instrument has not been regulated in the law so that the pharmacist profession is vulnerable to criminalization. The problem in this paper is (a) how is the legal protection of pharmacists in conducting home pharmacy care in the emergency services outside in their authority? How do you prevent the criminalization of pharmacists in conducting home pharmacy care? This study uses an empirical juridical and normative juridical approach. The results showed that the legal protection of pharmacists in carrying out home pharmacy care services in the emergency can carry out services outside their authority. The Indonesian Pharmacist Association (IAI) is obliged to provide protection to members as long as they carry out their duties in accordance with professional standards, professional service standards and operational procedure standards, and prevent the criminalization of pharmacists in practicing Home Pharmacy Care services. Suggestions by the authors in this study is expected the government to immediately issue a new law related to the validity of pharmacist activities in conducting home pharmacy care so that the existence of the law will guarantee legal certainty.

The Effect of Home Pharmacy Care Education on the Quality of Life of Diabetic Patients in Community Health Care

The Effect of Home Pharmacy Care Education on the Quality of Life of Diabetic Patients in Community Health Care

Penilaian Kebutuhan Home Pharmacy Care Untuk Pasien Diabetes Mellitus Tipe 2 Yang Disertai Hipertensi Pada Usia Lanjut

Home Pharmacy Care (HPC) merupakan pelayanan yang diharapkan dapat diberikan oleh apoteker untuk penyakit kronis maupun lanjut usia (lansia), namun pelaksanaannya masih jauh dari harapan pihak-pihak yang memerlukannya. Penelitian ini merupakan studi kualitatif pertama di Indonesia yang bertujuan untuk menilai kebutuhan pelayanan HPC untuk pasien lansia yang mengalami Diabetes Mellitus (DM) Tipe 2 disertai dengan hipertensi di Cilacap. Penilaian ini menjadi studi awal yang penting untuk penelitian berikutnya dalam rangka membuat model pelayanan HPC bagi pasien lansia.&#x0D; Sudut pandang pasien dan tenaga kesehatan digali untuk mengungkapkan kebutuhan HPC. Penelitian ini menggunakan metode kualitatif dan dilakukan dengan survei disertai wawancara mendalam. Survei dilakukan dengan cara menyebarkan kuesioner kepada apoteker untuk mendeskripsikan aktivitas yang perlu dilakukan dalam HPC beserta kendalanya dan merinci keterampilan yang diperlukan untuk melaksanakannya. Subjek penelitian berjumlah 32 orang apoteker, sedangkan informan terdiri dari 4 dokter, 3 perawat dan 5 pasien sehingga memenuhi kejenuhan data sebagai kecukupan sampel kualitatif.&#x0D; Hanya 3 apoteker (9,4%) dari keseluruhan subjek penelitian yang pernah memberikan pelayanan HPC, sedangkan sisanya belum pernah melaksanakannya, namun, semua pihak baik apoteker, petugas kesehatan maupun pasien menyatakan perlunya HPC untuk pasien dengan kondisi tersebut. Kendala yang terungkap dalam penelitian ini adalah keterbatasan sumber daya manusia, waktu dan finansial. Apoteker membutuhkan keterampilan edukasi obat, diet, aktivitas fisik dan pemeriksaan kaki bagi pasien disertai dengan kemampuan komunikasi yang memadai. Home pharmacy care masih jarang dipraktikkan di Cilacap, tetapi perlu untuk dilaksanakan dengan selektif karena didukung oleh dokter, perawat serta pasien. Kebutuhan HPC ini relevan untuk ditindaklanjuti dengan pembentukan model pelayanan kefarmasian.

Combination of Home Care Pharmacy Approach and Nurse’s Health Action Process Approach on Self Care Management and Self Efficacy in Elderly With Hypertension

Introduction: There are still many hypertensive patients with uncontrolled hypertension and experiencing barriers to self-care. This study attempts to increase motivation and intention in self-care management and self-efficacy through the implementation combination of home pharmacy care approach and Health Action Process Approach (HAPA). This study aimed to know the combination of the Home Care Pharmacy Approach and Nurse's HAPA on self-care management and self-efficacy in the elderly with hypertension. Methods: It was a pre-experimental study that used one group pretest post-test design approach with the population, 60 people. Inclusion criteria were respondents with average blood pressure ≥140/90 mmHg for two measurements. The sampling used a purposive sampling technique. The independent variable was the HAPA and Home Care Pharmacy. The dependent variable is self-care management and self-efficacy. Study instruments are questionnaire self-efficacy, self-care management, standard operating procedures, and HAPA Home Care Pharmacy. Data were analyzed by using paired t-test and Wilcoxon Sign Rank Test with significance paired α ≤ 0.05. Results: Statistical paired t-test showed there was an increase in self-care management (p = 0.006). Statistical Wilcoxon Sign Rank Test showed there was no influence on the home pharmacy care approach and HAPA on self-efficacy (p=0.753). Conclusions: It could be concluded that the implementation of collaboration in-home pharmacy care approach and HAPA improves self-care management. However, these interventions do not affect increasing self-efficacy. The excellent collaboration between healthcare providers will help patients maintain good health during treatment.

The Correlation Between Knowledge With Community Behavior In Antibiotic Use In Kelurahan Petukangan Utara With Home Pharmacy Care

Uncontrolled antibiotics use can induce antibiotics resistance cases. The community believe that antibiotics can cure all disease. Because of that Pharmacist is needed home pharmacy care related by antibiotics use knowledge to justify people's misconceptions. The main purpose of this research to analysis relationship between knowledge of behavior using antibiotics in Kelurahan Petukangan Utara with home pharmacy care. This research is non-experimental with a cross sectional study design. The sample used in this research was the community of Kelurahan Petukangan Utara with cluster random sampling metode is 101 responden by questionnaires. The data analysis used chi-square statistic test. The results showed that there were categories of antibiotic knowledge (55.4%) and antibiotic Behavior (53.5%). There is a significant relationship between knowledge with community behavior antibiotics use with p-value=0.015; OR: 4.979 in Kelurahan Petukangan Utara&#x0D; &#x0D;

EFFECT OF EDUCATION HOME PHARMACY CARE ON HYPERTENSION PATIENTS ‘LIVING QUALITY IN PUSKESMAS

Hypertension is one of ten degenerative diseases that decline the patient’s quality of life. Controlling hypertension through the role of pharmacists as a care giver in home pharmacy care activities can reduce the morbidity of the disease. The purpose of this study was to examine the effect of home pharmacy care education on the quality of life of hypertensive patients hospitalized at the Gamping II Public Health Center. This research design was quasi-experimental with a pre post control group. Respondents of this study were 28 hypertensive patients of the Gamping II Public Health Center. They were taken by simple random sampling and then divided into 2 groups, control and intervention. In the intervention group, respondents were given a pre-test and then educated with Home Pharmacy Care as many as 4 times. Data on blood pressure changes were measured using tensimeter, while quality of life assessment was SF-36 questionnaires. Data were analyzed by using student t-test. The results of this study showed that hypertensive patients are home pharmacy care services at Gamping II Public Health Center had significantly decreased blood pressures both systolic and diastolic (p &lt;0.05), while the quality of life showed a significant increase (p &lt;0.05). It was concluded that the application of home pharmacy care education to hypertensive patients in GampingPublic Health Center could reduce blood pressure and can statistically improve quality of life.

Peran Homepharmacycare pada Pasien Diabetes Mellitus Tipe II Prolanis terhadap Tingkat Kepatuhan dan Keberhasilan Terapi Di BP Sentra Medika Lebaksiu Tegal

Diabetes mellitus disease (DM) is chronic diseases due to the increase of glucose concentration in the body. The compliance and successful treatment of diabetes are needed to prevent complications. The patients’ compliance in using the medicine is an important factor of the successful therapy. One of the most comprehensive interventions for DM patients is Home Pharmacy Care. Objective: This study aims to determine the effect of Home Pharmacy Care role in patients with diabetes mellitus in increasing the compliance and successful therapy. Method: This research is pre experimental research conducted at Bp Sentra Medika Clinic and counseling at home respondents in Lebaksiu ,Tegal with using the method of one group pretest posttest design. Purposive sampling method is used in this research and got 35 respondents. Measurements were made using the MMAS-8 (pretest-postest) and pill count instrument to determine the patient's compliance level and the glucotest to measure the success of therapy characterized by blood sugar levels. Statistics test uses Wilcoxon and Mc Nemar to determine the effect of provision of Home Pharmacy Care intervention on compliace and successful therapy level. The results: showed that a total of 20 patients (57%) comliance to MMAS-8 and pill count scores and a total of 20 patients (57%) of successful treatment were achieved based on controlled blood glucose levels. Conslusion: The statistical test showed that there was a significant difference between before and after intervention marked with the value of p value of both tests was 0,000 so that there is an effect of giving Home Pharmacy Care toward the improvement of compliance and successful therapy.&#x0D; Keywords : diabetes mellitus, homepharmacycare, prolanis, compliance and successful therapy level

Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.

Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research is warranted to determine the optimal pharmacy service for home care patients and the most appropriate cpKPIs to measure its effects.

Implementation of Pharmaceutical Care Standard in Jambi City's Pharmacies

In the last five years, the pressure to implement pharmaceutical care focuses on the patient getting stronger. The current standard of pharmacy care at a pharmacy established by regulation of health minister number 73/2016, as a guideline for pharmacists and pharmacy technicians in organizing pharmaceutical care. This research was conducted in the city of Jambi in order to determine implementation of pharmaceutical care standard at pharmacy, to identify the supporting factors and inhibiting factors in implementing pharmaceutical care in the Jambi city’s pharmacy. This study is an observational descriptive study, conducted with a survey phase, followed by a phase of observation and in-depth interviews phase. Total respondents who conducted a survey of 105 pharmacist from 143 pharmacies. Then performed an observation using a checklist sheet at 20 pharmacies and in-depth interviews on 17 pharmacists. The questionnaire survey used convenience sampling technique and sampling techniques for observation and in-depth interviews with maximum variation sampling. Methods of data analysis was done descriptively to see the implementation of pharmaceutical care standard. Qualitative data were presented descriptively to identify supporting and barriers factors. Results of the research are based on a survey, in managing the pharmaceutical, medical supplies and consumable medical materials carried out by pharmacist assisted pharmacy technicians, but its implementation in the field is mostly done by the pharmacy technicians under the responsibility of the pharmacist. Clinical pharmacy services running on prescription services, drug information services and partly on the counseling. Home pharmacy care, monitoring drug therapy and monitoring of drug side effects and clinical documentation has not been done. Based on interviews unknown, factors supporting the implementation of the standard is support pharmacy technicians personnel, support of owner pharmacy, the presence of a pharmacist with a regular schedule of practices, the use of information systems technology and motivation of pharmacist. Whereas the barriers factor are factors in patients where there is doubt the patient to the pharmacist and staff, the limited presence of the pharmacist, the shortage of skills,and there is no space of counseling services and the limited number of pharmaceutical human resources.

Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing home-based care. Such evidence is needed to justify the expansion of this service nationally, including consistent and adequate remuneration from governments or other payers.