Homecare Pharmacy Services for High Risk Patients in Changhua County (2013)

Background: In 2012, Changhua county Health Bureau undertook the ”2012 Program for the Establishment of Homecare Pharmacy Services care model for High Risk patients” entrusted by the Ministry of Health and Welfare. It provides homecare pharmacy services to the population at high risk of inappropriate medication use, combining the seven major hospitals in Changhua county and community pharmacies and taking advantage of accessibility and professional knowledge to ensure the medication safety of patients.Methods: We included patients from Changhua Hospital (Ministry of Health and Welfare), Changhua Christian Hospital and its Branch hospitals (YuanSheng Hospital, Lukang Christian Hospital and Erlin Branch), Show Chwan Memorial Hospital and its Chang Bing Branch Hospital, each hospital included 15 patients. All patients were aged above 40 years and there were at least two chronic diseases. Pharmacists made their first visits to the patients during their hospital stay, explaining the purpose of the project, asking for permission to make two home visits, and obtaining written informed consent. The homecare pharmacy services to be provided by the pharmacists included the completion of related forms devised by the Taiwan Pharmacist Association.Results: 98 patients, aged from 46 to 97 years, were included in this study. 77.5% of the patients were elderly (＞ 65 years of age). All patients weighed from 44.4 to 91.4 kg, among which overweight patients (BMI 24 ~ 26.9 kg/m^2) accounted for 27% and obese patients (BMI ≥ 27 kg/m^2) for 30%. The main language of communication was Taiwanese (79.4%). Most patients (94.7%) lived with their families. 36.7% patients had a habit of drinking tea or coffee, and 17.2% of them smoked. Because this project included patients with chronic disease, the three main diseases were hypertension (80.6%), diabetes (52%) and hyperlipidemia (35.7%). Among the 79 patients with hypertension, 49 (62%) had blood pressure machines, and 39.2% (20 people) of the 51 diabetes patients had blood glucose meters. Only 46.9% of patients have influenza vaccination. According to medication analysis, the average number of prescription drug items the patients took was 10 ± 3.5, and each patient took an average number of 13.4 ± 5.9 pills each day. Most of the patients (67.4%) took medicine by themselves; 18.5% of the patients obtained help with taking medication from family members, and another 14.1% of the patients needed to have drugs administered by foreign caregiver. Based on an abilities assessment made by the person who administered the drugs, the main problems were poor literacy and poor vision, which accounted for 48.4% and 30.9%, respectively. The study showed that half of the patients only had a partial understanding of the medications they were taking. About 60% of the patients stopped taking drugs independently. 42.8% obtained medication guides or health education materials from their pharmacists, among which 22.4% of patients were helped to arrange drugs into pill boxes, and 18.4% of the pharmacists communicated with a physician on drug-related issues.Conclusion: Homecare pharmacy services and discharged patients can provide individualized, continuous holistic care. In addition to paying attention to correct medication, the services are also related to understanding patients' living environments, caring about their interactions with family members and their lifestyles. This program has erected a bridge through which patients can communicate with their physicians. Pharmacists should be fully equipped in all aspects, provide seamless patient care, and help patients to solve all medical issues, which saves the patient the trouble of resorting to different channels for various medical problems. Pharmacists should perform a full range of care, covering holistic care, families, the whole course of treatment, the whole team, and the whole district.