scholarly journals Pharmacist medication review: An integrated team approach to serve home-based primary care patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252151
Author(s):  
Michele Monzón-Kenneke ◽  
Paul Chiang ◽  
Nengliang (Aaron) Yao ◽  
Mark Greg
Keyword(s):  
Primary Care ◽  
Medication Review ◽  
Chronic Conditions ◽  
Inappropriate Medication ◽  
Team Approach ◽  
Patient Centered ◽  
Medication Discontinuation ◽  
Pilot Model ◽  
Home Based Primary Care ◽  
Home Based

Background Comprehensive medication review is a patient-centered approach to optimize medication use and improve patient outcomes. This study outlines a pilot model of care in which a remote corporate-based clinical pharmacist implemented comprehensive medication reviews for a cohort of medically complex home-based primary care (HBPC) patients. Method Ninety-six medically complex patients were assessed for medication-related problems. Data collected on these patients were: number of chronic conditions, number of medications, appropriate indication for each medication, dose appropriateness, drug interactions, recommendations for medication optimization and deprescribing. The number of accepted recommendations by the HBPC practice was analyzed. Results On average, the patients were 82 years old and had 13 chronic conditions. They were taking a median of 17 medications. Over a four-month pilot period, 175 medication recommendations were made, and 53 (30.3%) of them were accepted, with most common being medication discontinuation, deprescribing, and dose adjustments. Sixty-four (66.7%) patients were on a medication listed as potentially inappropriate for use in older adults. The most common potentially inappropriate medication was a proton-pump inhibitor (38.5%), followed by aspirin (24%), tramadol (15.6%), a benzodiazepine (13.5%) or an opioid (8.3%). Eighty-one medications were recommended for deprescribing and 27 medications were discontinued (33.3%). There were 24 recommended dose adjustments and 11 medications were dose adjusted (45.8%). Thirty-four medications were suggested as an addition to the current patient regimen, 2 medications were added (5.9%). Conclusion Pharmacist comprehensive medication review is a necessary component of the HBPC healthcare continuum. Additional research is needed to examine whether aligning pharmacists to deliver support to HBPC improves clinical outcomes, reduces healthcare expenditures and improves the patient’s experience.

scholarly journals The Team Approach to Home-Based Primary Care: Restructuring Care to Meet Individual, Program, and System Needs

2015 ◽  
Vol 63 (2) ◽  
pp. 358-364 ◽  
Author(s):  
Jennifer M. Reckrey ◽  
Theresa A. Soriano ◽  
Cameron R. Hernandez ◽  
Linda V. DeCherrie ◽  
Silvia Chavez ◽  
...  
Keyword(s):  
Primary Care ◽  
Team Approach ◽  
Home Based Primary Care ◽  
Home Based ◽  
Individual Program

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

Developing a model of home-based primary care in South Korea: A 1.5-year case study

2020 ◽  
Vol 40 (6) ◽  
pp. 1403-1428
Author(s):  
Chang-O Kim ◽  
Jongwon Hong ◽  
Mihee Cho ◽  
Eunhee Choi ◽  
Soong-nang Jang
Keyword(s):  
Primary Care ◽  
South Korea ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals Preparedness and Response Activities of the VA Home-Based Primary Care Program Around the Fall 2017 Hurricane Season

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 591-591
Author(s):  
Tamar Wyte-Lake ◽  
Claudia Der-Martirosian ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Program ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Early Implementation ◽  
Hurricane Season ◽  
Patient Health ◽  
At Risk Populations

Abstract Individuals aged seventy-five or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals can receive care at home. Concomitantly, large-scale natural disasters disproportionally affect both the medically complex and the older old, two patient groups responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs Home-Based Primary Care programs during the 2017 Atlantic Hurricane Season. These and similar programs under Medicare connect the homebound to the healthcare community. Study findings support early implementation of preparedness procedures and intense post-Hurricane patient tracking as a means of limiting reductions in care and preventing significant disruptions to patient health. Engaging with home-based primary care programs during disasters is central to bolstering community resilience for these at-risk populations.

scholarly journals HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S317-S318
Author(s):  
Jenny Ploeg ◽  
Marie-Lee Yous ◽  
Kimberly Fraser ◽  
Sinéad Dufour ◽  
Sharon Kaasalainen ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Home Care ◽  
Family Caregivers ◽  
Chronic Conditions ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Multiple Chronic Conditions ◽  
Team Approach ◽  
Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

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