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Home Medication Reviews by Pharmacists in Ontario, Canada

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02658604
Recruitment Status : Completed
First Posted : January 20, 2016
Last Update Posted : April 20, 2017
Sponsor:
Information provided by (Responsible Party):
Sherilyn Houle, University of Waterloo

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?

Condition or disease Intervention/treatment
Home Care Pharmacists Medication Therapy Management Other: Home medication review by a pharmacist

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Study Type : Observational
Actual Enrollment : 100 participants
Observational Model: Cohort
Time Perspective: Cross-Sectional
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 Start Date : January 2016
Actual Primary Completion Date : April 2017
Actual Study Completion Date : April 2017

Group/Cohort Intervention/treatment
Home visit by pharmacist
Patients of participating pharmacies age 65 or older, who are on 5 or more chronic prescription medications, and who have a need for, and agree to, a home visit by a pharmacist for a medication review.
Other: Home medication review by a pharmacist
Patients will receive a home visit from a pharmacist, including a medication review and the identification and addressing of drug therapy problems through patient education, the provision of pharmacologic and/or non-pharmacologic advice, or the adaptation of therapy or communication of recommendations to prescribers. All activities are within the current scope of practice for pharmacists in Ontario. A detailed assessment of the patient's medication inventory and organization/storage practices will be conducted, followed by a medication cabinet cleanup to help the patient organize their medications and discard any expired or discontinued medications. A list of inappropriate medications found in the home will be documented, detailing the reasons why they are inappropriate and if/how the patient is currently using these medications. With patient consent, inappropriate medications will be removed from the home and returned to the pharmacy for safe disposal.




Primary Outcome Measures :
  1. Mean number of drug therapy problems (DTP) identified per patient [ Time Frame: At time of home visit (cross-section), up to 6 months ]
    DTP definitions based on those of Hepler and Strand (1990)


Secondary Outcome Measures :
  1. Frequency distribution of drug therapy problem (DTP) type(s) across patient population [ Time Frame: At time of home visit (cross-section), up to 6 months ]
    DTP definitions based on those of Hepler and Strand (1990)


Other Outcome Measures:
  1. Mean number of high-risk medications used per patient [ Time Frame: At time of home visit (cross-section), up to 6 months ]
    High-risk medications are those defined by the Beers' Criteria



Information from the National Library of Medicine

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Ages Eligible for Study:   65 Years and older   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
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.
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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02658604


Locations
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Canada, Ontario
Shoppers Drug Mart #500
Toronto, Ontario, Canada, M4C1H6
Sponsors and Collaborators
University of Waterloo
Investigators
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Principal Investigator: John Papastergiou, BSc, BScPhm University of Waterloo
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Responsible Party: Sherilyn Houle, Assistant Professor, University of Waterloo
ClinicalTrials.gov Identifier: NCT02658604    
Other Study ID Numbers: 20836
First Posted: January 20, 2016    Key Record Dates
Last Update Posted: April 20, 2017
Last Verified: April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No