(1113) Integrating Community Pharmacists into Care Teams for Homebound Older Adults Living with Dementia: Perspectives of Home Health Providers

Objectives: Home-bound older adults living with dementia are often unable to access health and wellness services and have high levels of medication non-adherence. Community pharmacists can act as educators on medication management for people living with dementia and their family caregivers; however, pharmacists have traditionally not been added to home health teams. Thus, the purpose of this study is to investigate home health providers’ perspectives on collaborating with community pharmacists to develop and implement a pharmacist-led medication management service for homebound older adults living with dementia.

Methods: Data were collected through semi-structured telephone interviews. Eligible participants included nurses, physicians, physician assistants, therapists, home health aides, social workers, agency or program directors, administrative personnel, or billing technicians who were currently employed at home health agencies that provided medical care and/or non-medical supportive services in Alabama. We recruited participants via fax using contact information for Alabama home health agencies and supportive home care services obtained from the SeniorCare Directory and NPI Registry. Fax packets included a recruitment invitation, information letter, study flier, and interest form. Purposive sampling was also used to recruit home health providers by email invitation. Interviews were conducted by the last author, audio-recorded, and transcribed verbatim. Rapid content analysis was conducted by two investigators using the Consolidated Framework for Implementation Research (CFIR) as an a priori coding framework to assess patterns in barriers, facilitators, and organizational readiness to implement a pharmacist-led medication management service for homebound older adults with dementia. Coding was performed in Excel using a template based on CFIR constructs of inner setting, outer setting, intervention characteristics, and characteristics of individuals. Coding was discussed among the investigators until consensus was reached. Patterns in coding were summarized into descriptive themes and discussed among the investigators until final themes were agreed upon.

Results: We interviewed 5 representatives of home health agencies (nurses, social workers, and executive directors). Home health providers thought that pharmacist implementation of a medication management service for homebound older adults would be of great benefit. Three themes emerging from the interviews centered around the service business model, needed resources, and service elements. Regarding the business model, interviewees thought this service would be most feasible using external contracts with pharmacists versus direct employment in their home health company. Interviewees also liked the idea of pharmacists working at physician offices to conduct medication management services for homebound clients. Regarding resources, they expressed a need for a universal electronic health record between the pharmacist and home health providers. More resources for pill packing, separation of morning and nightly doses, and medication adherence technology for patients with memory loss were needed. Regarding service elements, pharmacist provision of medication reconciliation was emphasized for care coordination between multiple prescribers. Home visits were often discussed to visualize all medications in a patient’s household, as well as pharmacists providing patients/caregivers with medication education. Many interviewees expressed concern with home health non-nursing staff being legally unable to assist patients with taking medications, and mentioned pharmacists as a possible solution.

Conclusions: There is a need for pharmacist integration in home health agencies to assist in medication management for the aging population of patients. Pharmacists can help provide medication reviews, answer questions regarding new medications, and assist in management of medication lists. Pharmacists should familiarize themselves with technology to assist with medication adherence in homebound older adults with dementia. Development and testing of business models is needed to enhance collaboration between home health agencies and pharmacists. Future research should also investigate shared electronic health records between pharmacists and home health agencies to provide the most streamlined care.