Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton.
OBJECTIVE
The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes.


METHODS
The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists.


METHODS
We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998-2005).


METHODS
The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002.


RESULTS
In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs.


CONCLUSIONS
The pharmaceutical care service was fully and successfully implemented in Fribourg's nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.
Locca
Jean-François
JF
Community Pharmacy Practice Research Unit, Universities of Lausanne and Geneva, Pharmacie de la PMU, Rue du Bugnon 44, 1011 Lausanne, Switzerland.
Ruggli
Martine
M
Buchmann
Michel
M
Huguenin
Jacques
J
Bugnon
Olivier
O
D000368:Aged; D000369:Aged, 80 and over; D016527:Drug Costs / Q000706:statistics & numerical data*; D004513:Education, Pharmacy, Continuing; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D012189:Retrospective Studies; D013557:Switzerland