The benefits of in-home pharmacy evaluation for older persons

OBJECTIVE: To assess the potential benefit of a pharmacist performing in-home medication evaluations on frail older people. DESIGN: Prospective analysis with pre-post comparison. SETTING: A hospital-based home care program at the Sepulveda Veterans Affairs Medical Center. PARTICIPANTS: Male veterans in a home care program who live within 15 miles of the medical center and take three or more prescription medications (N = 20, mean age: 75.1 years). MEASURES: Prescribed medications were documented from the medical records and compared with regimens actually being followed in the home. In addition, the home was inspected, patients were educated, and recommendations were made to the prescribing physicians when necessary. RESULTS: At first visit, patients had a mean of 6.0 prescribed daily medications but were only taking 4.7 of these regularly. Also noted were many potentially unnecessary medications (70% of subjects) and multiple problems with the medication regimen (e.g., incorrect drug frequency or dosage, expired medications, medication omission). Follow-up visit revealed a significant decrease in medication discrepancies and problems (P less than or equal to .05). CONCLUSION: An in-home pharmacy assessment reveals many problems with drug administration not otherwise defected easily. These assessments can lead to potentially useful Interventions that can improve medication regimens and compliance. Determination of long-term effects must await controlled trials.