Exploring the role of the pharmacist within the Hospital@Home team at a tertiary centre in England
Authors: Sahota E , Lim R , McGlen S 
Published: April 2024

Abstract

Introduction
Hospital@Home (H@H) is an emerging healthcare model providing hospital-level care within patients’ homes (1). Despite its global presence for three decades, H@H adoption remains limited in the United Kingdom. The COVID-19 pandemic prompted National Health Service (NHS) England to promote virtual wards, including H@H, as an innovative care alternative (2). Among the pivotal functions in H@H are prescribing, administering, or stopping medications, where pharmacists play a critical role, undertaking these tasks along with the multidisciplinary team (MDT). However, there has been little research that investigates pharmacists’ scope of practice in H@H.

Aim
To explore the role of the pharmacist within the H@H team at a tertiary centre in England.

Methods
A qualitive study was conducted using 1) online (via Microsoft Teams) or in-person audio-recorded semi-structured interviews with pharmacists working in the tertiary centre’s H@H team, and 2) non-participant observations of purposively sampled MDT H@H team meetings; heart failure, general care and antibiotic. Pharmacists’ collaboration with MDT members, tasks they performed and how the MDT made decisions were the focus of the observations. Interview transcripts and observation field notes were concurrently analysed inductively to generate key themes. All three H@H pharmacists were approached to take part in the study. All members of the respective MDTs were recruited to take part in the observations. All participants gave informed consent.

Results
All three H@H pharmacists participated in interviews. Six MDT meetings were observed, attended by doctors (n=7), nurses (n=8) and pharmacists (n=3). Interviews lasted approximately 45 minutes each and MDT meetings lasted 30-120 minutes. Four main themes were generated from the analysis:
1. Scope of practice extends beyond a “traditional” pharmacist.
2. Being open-minded to a changing scope of practice.
3. Active collaboration with MDT members underpins and expands role.
4. Is intentional about, and advocates for the provision of patient-centered care.
Pharmacists’ varied scope of practice (e.g. participating/co-leading MDT meetings and conducting home visits) placed them in pivotal roles in patient care coordination, treatment planning, and decision-making. Pharmacists were open-minded and proactive in expanding the scope of H@H care, and their role. They continuously acquired new skills as they encounter and provide diverse care scenarios. Their specialised knowledge and skillsets were viewed by the MDT as an asset. Pharmacists were reflective practitioners, saw patients as complex individuals with specific needs to care for and advocated for their needs.

Conclusion
To our knowledge, this is the first study exploring the role of the H@H pharmacist in England, adding to the knowledge base in this emerging service delivery; pharmacists undertake non-traditional clinical roles in the team, work collaboratively with others to expand the service and their own skillset, to advocate for the need of patients. Although only three pharmacists were interviewed, this was the entire available sample. The study did not include home visit observations, which could provide insights into pharmacists’ interactions with patients in their homes. Future research can focus on complementing the findings of this study with in-depth exploration of the pharmacist’s role in H@H settings.

References
1. Kanagala SG, Gupta V, Kumawat S et al. Hospital at home: emergence of a high-value model of care delivery. The Egyptian Journal of Internal Medicine. 2023;35(1):21. doi:10.1186/s43162-023-00206-3
2. National Health Service. Guidance note: Frailty virtual ward (Hospital at Home for those living with frailty). Available from: https://www.england.nhs.uk/wp-content/uploads/2021/12/B1207-ii-guidance-note-frailty-virtual-ward.pdf