title: Pharmacist identification of medication-related problems in the home care setting.
abstract: OBJECTIVE
  To identify medication-related problems (MRPs) in home care patients.
  
  
  METHODS
  A prospective case series involving pharmacist medication review of patient charts.
  
  
  METHODS
  A nonprofit agency serving the disabled and elderly of Rockingham County, North Carolina.
  
  
  METHODS
  Patients living in their homes, who qualify for home health care and who take eight or more medications.
  
  
  METHODS
  Patients identified received at least one medication review performed by a pharmacist. Six types of MRPs were identified. Recommendations to resolve such MRPs were sent to the prescriber for analysis.
  
  
  METHODS
  Outcome measures include MRPs identified, recommendations, and prescriber acceptance.
  
  
  RESULTS
  380 charts received medication reviews from July 2007 through June 2009, and 148 (39%) required pharmacist intervention. A total of 232 MRPs were identified during the review process. Of the problems identified, suboptimal therapy (28%) and use of unnecessary drugs (24%) were most common. Discontinuing a drug (38.6%) and consulting the prescriber (23.2%) comprised the majority of the recommendations.
  
  
  CONCLUSIONS
  Pharmacists successfully identified a large number of MRPs not previously identified by other health care providers. Unnecessary drug use in home care patients was among the highest MRP noted. Discontinuation of an unnecessary drug was the most recommended resolution to the MRP. Prescribers respond positively to suggestions made by pharmacists regarding MRPs.
authors: University of Pittsburgh Medical Center, Shadyside Family Medicine Residency Program, Pittsburgh, Pennsylvania.
authors: Jessica
authors: J
authors: Vink
authors: Detra
authors: D
authors: Morton
authors: Stefanie
authors: S
authors: Ferreri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010595:Pharmacists; D019338:Polypharmacy