title: Clinical pharmacy services in the home: Canadian case studies.
abstract: OBJECTIVE
  To describe clinical home care services provided by Canadian pharmacists and to identify facilitators of and barriers to the provision of these services.
  
  
  METHODS
  Home care practices in Canada were identified using key informant and snowball sampling methods. Case descriptions of each pharmacy were composed using data obtained via a faxed questionnaire and a follow-up telephone interview.
  
  
  METHODS
  Community and institutional pharmacies across Canada.
  
  
  METHODS
  Sixteen pharmacists with practices that met three criteria: at least one home visit conducted per week, visits conducted specifically for clinical purposes beyond routine prescription counseling, and documentation of home care services.
  
  
  METHODS
  Faxed questionnaire and follow-up telephone interview.
  
  
  METHODS
  Pharmacist characteristics, pharmacy characteristics, types of clinical home care services, home care-related products and dispensing services, referral system, reimbursement, barriers and facilitators, and evaluative strategies.
  
  
  RESULTS
  Twelve practices were in community pharmacies, nine of them independents. Home care services were provided primarily to address noncompliance and at the request of other health professionals. Elderly patients were the predominant service recipients. Services provided in most practices included compliance support, medication regimen review, monitoring of new medications, and patient education and training. Less than one-third of practices compiled evaluative data on these services. Most practices did not bill for services rendered. Lack of reimbursement was cited as the most important practice barrier, and having other sources of funding, such as high prescription revenues, was viewed as the major facilitator.
  
  
  CONCLUSIONS
  Clinical home care practice is rare in Canadian pharmacy; reimbursement is a major barrier. Practices described in these case studies were initiated to address a perceived important patient need. To enable further dissemination of clinical home care practice, pharmacists need to establish formal linkages with other home care providers, evaluate their services, and use the data obtained to develop marketing and reimbursement strategies.
authors.affiliation: Faculty of Pharmacy and Home Care Evaluation and Research Centre, University of Toronto, Ontario, Canada. l.mackeigan@utoronto.ca
authors.forename: Linda D
authors.initials: LD
authors.lastname: MacKeigan
authors.forename: Joan A
authors.initials: JA
authors.lastname: Marshman
authors.forename: Dorothy
authors.initials: D
authors.lastname: Kruk-Romanus
authors.forename: David A
authors.initials: DA
authors.lastname: Milovanovic
authors.forename: Cynthia
authors.initials: C
authors.lastname: Jackevicius
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Einarson
mesh_terms: D002170:Canada; D003625:Data Collection / Q000379:methods; D003695:Delivery of Health Care / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010593:Pharmaceutical Services / Q000458:organization & administration*