Home Visitation Services Research Articles

Evaluation of aggression in Australian after-hours doctor home-visit services.

Minimizing the risks and distress arising from aggression in after-hours house call (AHHC) services will help improve service quality in the industry. Unfortunately, no national study has ever evaluated this in Australian AHHCs. Apart from reducing this gap, findings from this work will have global relevance given the rising popularity of the AHHC industry worldwide. A survey of all 300 doctors employed by the National Home Doctor Service, Australia's largest AHHC service provider. A validated electronic questionnaire was used to examine the doctors' experiences over a 12-month period. There were 168 valid responses (56% response rate). Aggression prevalence was 47.1%, and just over half (51.8%) of the cases came from the patients. "Verbal aggression" was the commonest (48.3%). Others are "threats" (26.6%), "vexatious complaints" (13.3%), "property damage" (4.2%), "physical violence" (4.2%), "sexual harassment" (2.8%), and "stalking" (0.7%). Majority of the respondents were concerned (90.2%) and apprehensive (75.2%) regarding the risks. Doctors who have experienced aggression were more likely to express apprehension (OR=3.99; CI=1.54-10.31; P=0.004), while those that have attained Postgraduate Fellowships (Vocationally Registered) were less likely to report experiences of aggression (OR=0.28; CI=0.09-0.84; P=0.02). Even though a higher proportion of females were concerned (92.3% vs 89.6%) and apprehensive (82.1% vs 73.6%) compared with males, these differences were not statistically significant (Fisher's Exact Tests: P=1.000 and 0.469, respectively). Aggression in Australian AHHC affects nearly 1-in-2 practitioners, with high levels of concern and apprehension being expressed. Concerned companies should do more to ensure that their doctors attain PG fellowships, as this is linked to lower reports of aggression. Where possible, family and friends need to be involved in patient care, as nearly half of the reported aggressions come from them.

An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service.

Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed. To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors. The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability. A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables. Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important. Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.

The influence of a mental health home visit service partnership intervention on the caregivers' home visit service satisfaction and care burden.

To investigate a community-based and hospital-based home visit partnership intervention in improving caregivers' satisfaction with home service and reducing caregiver burden. The community-oriented mental healthcare model prevails internationally. After patients return to the community, family caregivers are the patients' main support system and they also take the most of the burden of caring for patients. It is important to assist these caregivers by building good community healthcare models. A longitudinal quasi-experimental quantitative design. The experimental group (n=109) involved "partnership" intervention, and the control group (n=101) maintained routine home visits. The results were measured before the intervention, 6 and 12months after the partnership intervention. Six months after the partnership intervention, the satisfaction of the experimental group was higher than the control group for several aspects of care. Although the care burden was reduced in the experimental group, there was no significant difference between the two groups. This study confirms that the partnership intervention can significantly improve caregiver satisfaction with home services, without reducing the care burden. The community-based and hospital-based mental health home visit service partnership programme could improve the main caregiver's satisfaction with the mental health home visit services, while the reduction in care burden may need government policies for the provision of more individual and comprehensive assistance.

Design matters in home visiting improvement

Maternal and child health home visiting services play a critical role in healthcare within the United States. Programs are widely varied and services offered depend on local and regional adopted designs. Observational and experimental research provides mixed conclusive results. Some literature reports statistically significant positive outcomes for home visitation services while other research fails to duplicate or provide secondary matched findings. Future research design opportunities include national, inclusive, cross collaborative home visiting research that seeks to minimize limitations. Future home visiting programs should utilize research opportunities in public and private program redesign, continuous quality improvement as well as in accreditation for optimal effect on target populations. Only with strong, supportive research can maternal and child home visiting services be tailored, replicated and consistent across the United States.

Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of “Dads matter”

Despite mounting evidence on the importance of fathers in children’s development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the “Dads Matter” enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen’s d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers’ involvement with the child, maltreatment indicators, and fathers’ verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers’ engagement in home visiting services and promoting family and child well-being.

Early Childhood Home Visiting.

High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.

Antepartum Services and Symptoms of Postpartum Depression in At-Risk Women

ObjectiveTo examine which psychosocial risk factors are predictors of symptoms of postpartum depression (PPD) and whether home visit services are associated with decreased reports of symptoms of PPD. DesignSecondary analysis of observational data from the 2012 to 2013 Pregnancy Risk Assessment Monitoring System (PRAMS). ParticipantsA national sample with data from more than 30,000 births from 41 states. MethodsTo account for unequal probabilities of selection, PRAMS-produced survey weights were incorporated in all percentage estimates, all chi-square tests, and an overall logistic regression model for maternal characteristics as predictors of symptoms of PPD. The effect of interventions on PPD was assessed using statistical techniques that adjusted for the likelihood of receiving the intervention. ResultsStressors (odds ratio [OR] = 2.6 for three to five stressors; OR = 3.1 for six or more stressors), physical abuse (OR = 1.8), and history of depression (OR = 3.0) were associated with PPD in the logistic regression model. Using propensity score analysis, the average treatment effect of home visiting on PPD, during or after pregnancy, was nonsignificant. However, the propensity score analysis did identify a group of high-risk women for whom receiving a home visit was associated with nearly 40% lower odds (OR = 0.6) of experiencing PPD symptoms. ConclusionFindings highlight the effect home visits during pregnancy may have on the odds of at-risk women developing symptoms of PPD. Future research is indicated to assess the extent to which targeted interventions during these home visits can enhance effectiveness by mitigating psychosocial stress in pregnancy to prevent PPD.

328 Going the distance – patient opinion on an adult CF centre dietetic and diabetes home visit service

328 Going the distance – patient opinion on an adult CF centre dietetic and diabetes home visit service

EFFECTS OF INDIRECT NUTRITIONAL INTERVENTION BY A REGISTERED DIETITIAN THROUGH VISITING NURSES IN NUTRITIONALLY AT-RISK OLDER HOME-CARE RECIPIENTS: A RANDOMIZED PILOT STUDY

Objectives: Home-visit nutritional support services by registered dietitians for home-care patients are not popular due to a shortage of visiting registered dietitians. This study examined the effects of indirect nutritional intervention by a registered dietitian through visiting nurses in community-dwelling older home-care recipients. Design: A randomized, open-label, controlled clinical trial. Setting: Community. Participants: Thirty-four nutritionally at-risk older home-care recipients aged 65 years or older who were receiving home-visit nursing care services. Intervention: Dietary counseling promoting highly varied food intake provided by visiting nurses trained by a registered dietitian. Measurements: Nutritional status based on the Mini Nutritional Assessment-Short Form (MNA®-SF), dietary variety, anthropometric measurements, activities of daily living, and subjective diet-related quality of life were measured at baseline and after three months. Results: Nutritional status tended to improve in the intervention group (P = 0.087). Analysis of the changes of MNA®-SF item scores revealed significant improvement in “Appetite loss” (P = 0.046) and a trend toward improvement in “Weight loss” (P = 0.053) in the intervention group. Conclusion: Indirect nutritional intervention by a registered dietitian through visiting nurses was effective in improving the nutritional status of nutritionally at-risk older home-care recipients.

Health Promotion Behavior, Perceived Health Status, Social Participation and Empowerment in Frail Elderly Receiving Home Visiting Services

Health Promotion Behavior, Perceived Health Status, Social Participation and Empowerment in Frail Elderly Receiving Home Visiting Services

Evaluation of System Development and Organization Regarding the Participation System of Pharmacists in Home Medical Care Support

Although medical care is shifting from facility-completed to community-completed type, currently there is only a small number of pharmacists' participating in home medical care. This is due to problems in the participation system including; information inadequacy of the pharmacies available for home visit service (information discrepancy between submitted information and actual availability), inadequate recognition of pharmacists' roles and operations on home medical care, visible relationship building, etc. Therefore, we have established the promotion committee of home medical care and have taken various measures. At the committee, we have created a map of pharmacies supporting home medical care (with information of availability for home visit service and available area / time), construction and operation of a system for searching pharmacies with narcotics' inventory from drug names, preparation of information and documents necessary for participation, creation and distribution of a brochure for public relations of the home visiting pharmaceutical service, and improvement of the multidisciplinary cooperation through training sessions, etc. based on the results of a home medical care survey conducted in all the insurance pharmacies in the area. As a result, we have gained the recognition and understanding of the pharmacists' roles, etc. having led to an increase in the number of medical institutions available for home visit service and pharmacies participating in home medical care accordingly. We could establish a system by which pharmacists support home medical care by addressing various problems affecting pharmacists.

Social Determinants and Health Disparities Associated With Outcomes of Women of Childbearing Age Who Receive Public Health Nurse Home Visiting Services

ObjectiveTo examine the associations between social and behavioral determinants of health (SBDH), health disparities, and the outcomes of women who received public health nurse home visits for pregnancy and parenting support. DesignObservational exploratory data analysis and comparative outcome evaluation. SettingAn extant dataset from women served in a Midwestern U.S. state, including demographics and Omaha System problems, signs/symptoms, interventions, and outcome assessments. ParticipantsWomen (N = 4,263) with an average age of 23.6 years (SD = 6.1); 21.4% were married, and 39.1% were White. MethodsAn evaluation dataset was constructed that included all women of childbearing age, their demographics, and outcome assessments. A summative SBDH Index based on Institute of Medicine-recommended instruments was computed based on sign/symptom data. Visualizations were developed using Microsoft Excel, and outcome significance statistics were computed using SPSS version 22 and SAS version 9.4. ResultsOutcome evaluation showed positive, significant changes from baseline after public health nurse intervention. Visualization showed variable concentrations of problem-specific signs/symptoms by SBDH Index subgroups. There were between-group differences in overall outcome attainment across SBDH Index subgroups. Compared with White women, minority women had greater improvement; however, despite these gains overall minority final ratings were lower. ConclusionAn informatics approach showed that SBDH are important factors for understanding a comprehensive and holistic view of health and health care outcomes. There is potential to use large datasets to further explore intervention effectiveness and progress toward health equity related to SBDH.

The first Japanese trial of the community-based integrated care system in a rural area

Introduction: Japan has the highest elderly rate of population in the world. In 2012, the government implemented the community-based integrated care system, which integrates various health-related resources within the community through cooperation among formal, long-term care facilities, welfare and medical care specialists, and informal voluntary activities by the residents. The system was first born in a rural town in Hiroshima.Description of the policy: This presentation shows how a trial in a typical rural town achieved the community-based integrated care system, influenced the governmental policies, and became the first model for the subsequent nationwide reform of healthcare system. In 1970s, the aging population has been prominent in Mitsugi. At that time, care for the elderly was fragmented into various service sections. An integrated care system marshaling all services and providing an integrated delivery system, which was later called the community-based integrated care system, has been gradually constructed in Mitsugi as follows.Firstly, in 1970s, the hospital started providing home-visit services; doctors, nurses, long-term care workers and the like would visit patients’ houses, support their life at home instead of patients coming to the hospital. It promoted linkage between care services in the hospital and at home. Secondly, the Health Management Center was opened as an annex of the hospital in 1984. This center involved some departments of the municipal government, which had been responsible for the preventive, welfare and long-term care services in those days. It enabled the hospital to play a role in not only medical but also preventive, welfare and long-term care services, which facilitated providing these services seamlessly. Thirdly, long-term care facilities such as a nursing home and a group home for demented elderly patients were established. These facilities made long-term care possible for the elderly people that cannot be cared for at home. Lastly, Mitsugi launched volunteers’ action by community citizens to help the elderly with the cooperation of the hospital. This volunteer system has formed the connection between residents and the hospital, which has made more seamless community-cooperative comprehensive care possible.Results: After the system, the proportion of bedridden people decreased remarkably from 3.5 to 1% in this town. In addition, this system realized slowing growth of healthcare costs, while they were then rapidly increasing throughout the rest of Japan. Although healthcare costs for elderly in Mitsugi were above average in Hiroshima prefecture until about 1985, the status has since been reversed, maintaining a lower level than the prefectural mean. After its success, the first community-based integrated care system case in Mitsugi became the model for the national policy implemented in 2012.Highlights: Success in a small rural town can influence the entire country. This is the first case of diffusion of a healthcare system from rural to urban areas, which is unusual. The reasons why the first community-based integrated care system arose in Mitsugi are the aging of the population, easy integration of services due to its small size, the economic support from the prefecture, and existence of a leader that coordinated different sectors of healthcare.Conclusion: There are three future tasks to sustain the community-based integrated care system. Firstly, the system suitable for each community should be constructed. Secondly, vigorous resident participation is needed in this system so that they can find and introduce neighbors that need medical or long-term care services to the system. Finally, finding ways to reduce the costs for medical and long-term care services at a nationwide level.

An evaluation of an integrated model of speech and language therapy in public health practice for early language development

Speech and language therapists (SLT) frequently operate in an integrated manner, working with other professionals in the delivery of services to children. Since the end of the 1990s within the UK SLTs have developed integrated services within the field of public health. This study reports an evaluation of an integrated model of service delivery for a family focused health promotion service for early language development, the Babytalk Home Visiting (BTHV) service in terms of reach and perceived quality of service delivery. Children’s Centres workers were trained to deliver the service alongside existing SLT assistants. Ongoing supervision was delivered by the SLT service. The effect of integrated staffing was compared with the original single agency model through comparison of contact monitoring data and parental feedback questionnaires. Availability of the BTHV service was successfully extended by a factor of 4.46 and actual contacts by a factor of 3.96 compared to a staffing increase of a factor of 2.88. There was no evidence of a significant difference between results of parental evaluation forms from the extended service and the original service, indicating that the quality of service delivery was not compromised. Limitations of evaluation methods are highlighted and research priorities recommended.

Changes in vital signs as predictors of bacterial infection in home care: a multi-center prospective cohort study

ABSTRACTObjectives: To explore whether the combination of changes in heart rate and body temperature can predict bacterial infection in home care patients.Methods: This multicenter, prospective cohort study was conducted in Japan from March 2012 through December 2013 and involved three clinics. The study population comprised all patients who received regular home visit services for at least 3 months and met one of the following inclusion criteria: 1) fever over 37.5°C at home visit, 2) physician’s clinical suspicion of fever, or 3) physician’s suspicion of bacterial infection. We collected temperature and heart rate data on the day of enrollment, and determined the probable causes of fever after treatment of febrile episodes. We defined the combination of changes in heart rate and body temperature as delta HR/BT. We calculated two types of delta HR/BT, averaged and assumed, using different baseline values for heart rate and body temperature.Results: A total of 124 patients were enrolled and 194 episodes of fever were analyzed during the study period. The sensitivity, specificity, positive predictive value, and negative predictive value for the average delta HR/BT with a cut-off ≥ 20 were 20.4% (95% CI, 16.7–23.3), 84.2% (95% CI, 75.2–91.0), 75.7% (95% CI, 61.8–86.2), and 30.6% (95% CI, 27.3–33.0), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for the assumed delta HR/BT with a cut-off ≥ 5 was 91.2% (95% CI, 89.2–94.0), 8.9% (95% CI, 4.1–15.7), 70.9% (95% CI, 69.3–73.0), and 29.4% (95% CI, 13.6–51.8), respectively.Conclusions: The combination of changes in heart rate and body temperature could help physicians determine whether home care patients have bacterial infections.

Nurses’ experiences of home visiting new parents in rural and regional communities in Australia: a descriptive qualitative study

Purpose Child and family health (CAFH) services in Australia initially provide at least one nurse-home-visit following the birth of a child. Planning and referral then commences for the on-going provision of appropriate services to families. Unfortunately, services in rural and regional communities in Australia can be fragmented and poorly resourced. Little is known about CAFH nurses’ experiences of working with families in these communities. The purpose of this paper is to examine the way CAFH nurses work within a universal health service model that may be compromised by isolation, discontinuity and fragmentation. Design/methodology/approach Focus groups with 26 CAFH nurses from five rural, two regional and one urban community in New South Wales (NSW), Australia were conducted. A secondary, thematic analysis of the qualitative data were undertaken to reflect on change and continuity in the field of universal CAFH services. Analysis was driven by two key research questions: How do CAFH nurses experience their role in universal home-based CAFH services within rural and regional areas of Australia and, what unique factors are present in rural and regional areas that impact on their CAFH nursing role? Findings The experience of the CAFH nurses as presented by these data revealed a role that was family centred and concerned for the welfare of the family, yet compromised by the need to meet the disproportionately complex needs of families in the absence of a strong network of services. The opportunity to present the findings provides insight into the way in which families engage with available services in isolated communities. CAFH nurses in the study attempted to maintain service integrity by adapting to the unique context of their work. Originality/value It is important to understand the mechanisms through which CAFH nurses operate to work effectively with families referred to their service. This paper describes the way in which CAFH nurses work with families not meeting the threshold for more intensive and targeted home-visiting service delivery in rural and regional communities of NSW, Australia.

Levels and predictors of patient satisfaction with doctor home-visit services in Australia.

The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service. This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries. A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18). A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household. This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls.

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Mindfulness among Home Visitors in Head Start and the Quality of Their Working Alliance with Parents

The effectiveness of home-visiting programs in improving children’s health, developmental, and educational outcomes may depend, in part, on the quality of the relationships between home visitors and parents, one aspect of which is their working alliance (shared bonds, goals, and tasks). However, little is understood about what modifiable factors are associated with a stronger working alliance. The purpose of this study was to determine if home visitors with higher levels of dispositional mindfulness reported a stronger working alliance with parents and whether this association was mediated by greater psychological well-being in the home visitor. In the spring of 2012, an anonymous, web-based survey was administered in 50 Head Start and Early Head Start programs in Pennsylvania. Responses were received from 307 of 418 (73.4 %) home visitors. Home visitors reported on dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised), psychological well-being, and their working alliance with parents (modified Working Alliance Inventory, Short Form). After controlling for confounders, a 1 SD higher mindfulness score among home visitors was associated with a 0.27 higher score on their working alliance with parents (p < 0.001). This association was mediated by visitors’ positive psychological well-being [indirect effect = 0.12, 95 % confidence interval (0.08, 0.21)]. Among home visitors in Head Start and Early Head Start, those who had higher levels of mindfulness reported a stronger working alliance with parents. Interventions to promote mindfulness among home visitors may be one approach to strengthening their working alliance with parents and the effectiveness of home-visiting services.

Pharmacist home visits: A 1-year experience from a community pharmacy

ObjectiveTo provide experience on the methods and costs for delivering a large-scale community pharmacist home visit service. SettingIndependent urban community pharmacy, Buffalo, NY. Practice descriptionMobile Pharmacy Solutions provides traditional community pharmacy walk-in service and a suite of clinically oriented services, including outbound adherence calls linked to home delivery, payment planning, medication refill synchronization, adherence packaging, and pharmacist home visits. Pharmacist daily staffing included three dispensing pharmacists, one residency-trained pharmacist, and two postgraduate year 1 community pharmacy residents. Practice innovationA large-scale community pharmacy home visit service delivered over a 1-year period. EvaluationPharmacist time and cost to administer the home visit service as well as home visit request sources and description of patient demographics. ResultsA total of 172 visits were conducted (137 initial, 35 follow-up). Patients who received a home visit averaged 9.8 ± 5.2 medications and 3.0 ± 1.6 chronic disease states. On average, a home visit required 2.0 ± 0.8 hours, which included travel time. The percentages of visits completed by pharmacists and residents were 60% and 40%, respectively. The amounts of time to complete a visit were similar. Average home visit cost including pharmacist time and travel was $119 ($147 for a pharmacist, $77 for a resident). ConclusionIn this community pharmacy–based home visit service, costs are an important factor, with each pharmacist visit requiring 2 hours to complete. This experience provides a blueprint and real-world perspective for community pharmacies endeavoring to implement a home visit service and sets a foundation for future prospective trials to evaluate the impact of the service on important indicators of health and cost.