Clinical trial NCT02658604: Home Medication Reviews by Pharmacists in Ontario, Canada
Official title: Home Medication Review Services for Non-homebound Community Pharmacy Patients: Evaluation of Medication Management Issues in Non-homebound Patients and Characterization of Ideal Target Population for Home-based Medication Reviews.
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Home Care
Pharmacists
Medication Therapy Management
Lead sponsor: University of Waterloo
Sponsor class: OTHER
First posted: 2016-01-20
Enrollment: 100
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Current patients of participating pharmacies who are aged 65 and older, live at home, and are on 5 or more medications.

Brief summary: RATIONALE:

Several examples in the literature describe the types of medication management issues uncovered during the course of home-based medication reviews. For example, the investigators previously reported the outcomes of home medication reviews of 43 homebound community pharmacy patients, finding that 58% of patients were keeping medications in the home that were expired, duplicates of other current medications, or no longer therapeutically appropriate.

Many of these issues, due to their nature, could be considered to be "hidden", i.e. issues that are unlikely to be adequately detected or resolved during the course of routine interactions between patients and pharmacists in the community pharmacy setting. Currently, only homebound patients in Ontario are eligible to receive government-funded home medication review services from pharmacists. This limitation in funding eligibility is problematic as it reduces the likelihood that non-homebound patients will receive home medication reviews, even though this population may also benefit from these services. Indeed, evidence in the literature is not limited exclusively to homebound patients, and suggests that non-homebound patients are also at risk from home-centered medication management issues and may also benefit from home medication reviews.

PURPOSE:

Our study aims to characterize the prevalence and nature of "hidden in the home" medication management issues in non-homebound patients. To our knowledge, this study would be the first of its kind to focus specifically on this patient population and lend direct evidence in support of expanding funding of home medication review services in Ontario to include non-homebound patients.

HYPOTHESIS:

A subset of ambulatory, non-homebound patients who regularly attend community pharmacies are affected by medication management issues that cannot be adequately identified and resolved during the course of a typical medication review taking place within the pharmacy. These patients would benefit from a full medication review taking place in their own homes, similar to what is presently provided under Ontario's MedsCheck at Home program, for which only homebound patients in Ontario are eligible.

RESEARCH QUESTIONS/OBJECTIVES:

1. What is the frequency of, and what type(s) and severity of, drug-related problems are detected during pharmacist visits to patients' homes who would not otherwise qualify for a MedsCheck at Home service?
2. Based on the findings from this study, which criteria would best assist community pharmacists in identifying ambulatory patients who may stand to benefit most from a home-based medication review?


Eligibility criteria: Inclusion Criteria:

* Age 65 or older
* On 5 or more chronic prescription medications
* Score of 3/8 or higher on screening questionnaire
* Live at home and are ambulatory
* Willingness to have a pharmacist conduct a medication review in their home

Exclusion Criteria:

* Unable to converse with the pharmacist in a language they both can communicate in

Primary outcomes:
measure: Mean number of drug therapy problems (DTP) identified per patient
timeFrame: At time of home visit (cross-section), up to 6 months
Secondary outcomes:
measure: Frequency distribution of drug therapy problem (DTP) type(s) across patient population
timeFrame: At time of home visit (cross-section), up to 6 months
Other outcomes:
measure: Mean number of high-risk medications used per patient
timeFrame: At time of home visit (cross-section), up to 6 months
Locations:
city: Toronto
country: Canada
facility: Shoppers Drug Mart #500
state: Ontario
Study officials:
affiliation: University of Waterloo
name: John Papastergiou, BSc, BScPhm
role: PRINCIPAL_INVESTIGATOR
References: