The scope of drug-related problems in the home care setting
- 716 Downloads
Introduction While drug-related problems (DRPs) in the inpatient setting are well known, the scope of these problems in home care has not been critically evaluated. Aim of the Review Our primary objective was to evaluate the incidence and demographics of DRPs in home care. Our specific aims were to characterize the rate of potentially inappropriate medications (PIMs), medication errors (MEs) and adverse drug events (ADEs) and to identify risk factors which contribute to DRPs in the home care setting. Methods Pubmed, Embase and CiNAHL databases were systematically searched from January 2000 to December 2016 for all publications which quantitatively characterized DRPs in the home care setting. Results The most commonly reported DRPs characterized in studies were PIMs (n = 16), MEs (n = 4) and the ME-subcategory medication-related discrepancies (n = 7). The frequency of PIMs ranged from 19.8 to 48.4%; up to 26% PIMs were considered severe. Polypharmacy (≥ 9 drugs) and increasing age were the most common risk factors for DRPs. Insufficient interdisciplinary teamwork and inconsistent performance of medication reviews were also risks factors for DRPs. Patients and/or caregivers were responsible for 42.3% of DRPs. Discussion Compared with acute inpatient care, DRPs are more frequently reported in home care. The rate of DRPs varies depending upon the reference used to define the problem. Conclusion Transfer of complete medical records and the use of an interdisciplinary team have the potential to reduce DRPs, including MEs, specifically when integrating a pharmacist providing regular medication review. Importantly, patients and informal caregivers must be significant partners with this interdisciplinary team.
KeywordsDrug-related problems Home care Interprofessional collaboration Medication safety Seamless care Transition of care
The authors would like to thank Heidrun Janka, Medical Library, University of Basel/Switzerland for her guidance in systematically navigating the medication safety literature.
Part of this work was funded by the non-for-profit Home Care Organization Spitex Stadt Luzern/Switzerland, the Spitex Association of the Canton of Lucerne/Switzerland, the Department of Health of the Canton of Lucerne/Switzerland, and the LOA IV foundation of the Swiss Society of Pharmacists and the Swiss health insurance companies.
Conflicts of interest
The authors declare that they have no conflicts of interest.
- 15.Onda M, Imai H, Takada Y, Fujii S, Shono T, Nanaumi Y. Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ Open. 2015;5(8):e007581.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Johnson KG. Adverse events among winnipeg home care clients. Heal Q. 2006 9: 127–34.Google Scholar
- 20.Hamano J, Ozone S, Tokuda Y. A comparison of estimated drug costs of potentially inappropriate medications between older patients receiving nurse home visit services and patients receiving pharmacist home visit services: a cross-sectional and propensity score analysis. BMC Heal Serv Res. 2015;15:73.CrossRefGoogle Scholar
- 31.Hale J, Neal EB, Myers A, Wright KH, Triplett J, Brown LB, et al. Medication discrepancies and associated risk factors identified in home health patients. Home Heal Now. 2015;33(9):493–9.Google Scholar
- 34.Classen S, MStat WM, Walsh K, Mann W. The relationship of classes of commonly prescribed medications to functional status and quality of life for frail home-based older adults. Phys Occup Ther Geriatr [Internet]. 2006 Jan 28 [cited 2017 Jan 1];24(1):25–44. Available from: http://www.tandfonline.com/doi/full/10.1080/J148v24n01_02.
- 35.Triller DM, Clause SL, Briceland LL, Hamilton RA. Resolution of drug-related problems in home care patients through a pharmacy referral service. Am J Heal Syst Pharm. 2003;60(9):905–10.Google Scholar
- 38.Doran D, Hirdes JP, Blais R, Baker GR, Poss JW, Li X, et al. Adverse events associated with hospitalization or detected through the RAI-HC assessment among Canadian home care clients. Heal Policy. 2013;9(1):76–88.Google Scholar
- 41.Dilks S, Emblin K, Nash I, Jefferies S. Pharmacy at home: service for frail older patients demonstrates medicines risk reduction and admission avoidance. Clin Pharm. 2016;8(7). https://doi.org/10.1211/CP.2016.20201303.
- 42.Berti G, Bacchetto FM, Lebboroni M, Faronato PP, Alberti G. Analysis of patient prescriptions about home assistance integrated. G Ital di Farm Clin. 2007;21(2):82–8.Google Scholar
- 52.Roten I, Marty S, Beney J. Electronic screening of medical records to detect inpatients at risk of drug-related problems. Pharm World Sci. 2009;1573–739X.Google Scholar
- 55.MacAulay S, Saulnier L, Gould O. Provision of clinical pharmacy services in the home to patients recently discharged from hospital: a pilot project. Can J Hosp Pharm. 2008. https://doi.org/10.4212/cjhp.v61i2.26.
- 57.Ward KT, Bates-Jensen B, Eslami MS, Whiteman E, Dattoma L, Friedman JL, et al. Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project. Am J Geriatr Pharmacother [Internet]. 2008;6(4):205–11.CrossRefGoogle Scholar
- 58.Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004;2(4):257–64.CrossRefPubMedGoogle Scholar
- 59.Ensing HT, Koster ES, van Berkel PI, van Dooren AA, Bouvy ML. Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther 2016.Google Scholar
- 64.Wekre LJ, Spigset O, Sletvold O, Sund JK, Grimsmo A. Multidose drug dispensing and discrepancies between medication records. Qual Saf Heal Care. 2010;19(5):e42.Google Scholar