(1112) Implementation and Evaluation of a Long Term Care at Home Service in a Rural Community Pharmacy Setting

Objectives: The aim of this project is to evaluate the implementation of a long term care at home service in a rural community pharmacy setting in Eastern Iowa. The objectives of this study are to: 1) Describe implementation and challenges of a long-term-care at home service in a rural community pharmacy setting. 2) Describe pharmacist clinical interventions including the identification and resolution of drug therapy problems. 3) Measure patient/caregiver satisfaction with the service. This service will be targeted to those individuals who are unable to afford residing in a long term care facility or would prefer to stay in their homes for longer. Providing long term care services in the home can provide longevity and improved quality of life for these individuals.

Methods: This study is a pilot evaluation of a community pharmacist delivered intervention. The patient identification process will begin by querying the pharmacy’s database software to identify potential patients. A pharmacy technician will use a qualification form to determine eligibility. Eligibility requirements are set by Centers for Medicare & Medicaid Services (CMS) and includes the patient taking 6 or more medications, having 3 or more chronic conditions, and having 3 or more ADL/iADL limitations. Once a patient is determined to qualify, a pharmacist will perform a comprehensive medication review to identify any current drug therapy problems and communicate with providers as necessary. A pharmacist or technician will begin processing the patient’s prescriptions and synchronize them for placement into monthly adherence packaging. Adherence packaging consists of four weekly medication blister packs divided into morning, noon, evening, and bedtime slots from Sunday to Saturday. The medications will be delivered to the patient’s home by either a delivery support person or a pharmacist if needed. A pharmacist home visit may be warranted for patient care services, such as vaccine administration or device education. This process will occur each month as long as the patient continues to qualify. Following the data collection period, a survey will be given to patients and/or caregivers to assess satisfaction and suggestions for how the service can be improved. This will be a paper survey delivered with their medications that patients can either return with a delivery driver or mail back to the pharmacy. Data to be collected will include average number of medications and conditions per patient, pharmacist identified drug therapy problems, patient/prescriber accepted interventions, insurance type, reimbursement amounts, and overall patient/caregiver satisfaction.

Results: Research in progress.

Conclusions: This service has the opportunity to fill a gap in care for patients who could qualify for a long term care or assisted living facility but have the strong desire to stay in their home. The intention is to close this gap by improving home medication management and overall safety in the home to delay the need of admission to a care facility.