Case study: Pharmacy domiciliary service helps integrate care for housebound patients

A research paper about a community pharmacist-led holistic domiciliary Medicines Use Review (MUR) service has been published in the Research in Social and Administrative Pharmacy journal.

The study, Can community pharmacy successfully bridge the gap in care for housebound patients? concludes that domiciliary visits by community pharmacists can highlight the diverse care needs of housebound patients and help to integrate their requirements.

What did the service involve?

Patients were identified in the London Borough of Richmond who were predominantly housebound and taking multiple medicines. Twelve community pharmacists visited patients and carried out interviews as part of a structured holistic domiciliary MUR.

What did the pharmacists identify?

A total of 133 patients were visited by community pharmacists and 401 clinical, social or medicines-related issues were recorded.

Nearly 20% of patients had recently run out of a medicine. A significant number of patients had physical difficulties taking their medicine, with the reasons identified including a lack of dexterity in opening a blister, applying eyedrops or using inhalers and difficulties in swallowing medicines. A patient with respiratory disease had been without inhaled steroids for several months as she could not use the prescribed and dispensed inhaler.

Over a third of patients had unwanted medicines for disposal, ranging from 1-20 different types of medicines. Some patients had stockpiled medicines whilst others were no longer taking a medicine but had not informed the pharmacy.

Patients with diabetes and those taking warfarin were not being regularly monitored and over a quarter of patients reported both preventable and potentially dangerous side effects.

Various social care issues were also identified by the pharmacists; this included damp and cluttered homes, the frequent presence of physical and gas hazards, and inadequate hydration, nutrition and lavatory facilities.

What did the study conclude?

The study concluded that community pharmacists may be a link in the care pathway to help integrate many aspects of care for older, isolated, housebound patients with multiple-morbidities. This may consist of understanding the patient’s medicines and care needs in the context of their home environment, providing missing medicine support to carers and family members, helping to optimise patients’ medicines and making referrals as appropriate.