Building a home care medication therapy management practice at a visiting nurse agency

Objectives:

The purpose of establishing a home care medication therapy management (MTM) program at the Minnesota Visiting Nurse Agency (MVNA) was to create a practice integrated within the home care practice model to serve the medication-related needs of home care patients.

Methods:

Patients taking nine or more medications (including over the counter and herbal products) were offered a pharmacist home visit in which the pharmacist evaluated all medications for indication, effectiveness, safety, and convenience. Recommendations were communicated to clinicians and follow-up care was coordinated by the pharmacist, home care nurse, patient, and caregiver.  

Results:

From January 1, 2009 to December 31, 2010, 165 patients received an MTM visit.  The average patient was 61 years old, had seven medical conditions, took 15 medications and had three medication-related problems.  The most common medication-related problems were related to convenience (37%) and indication (29%).  Sixty-eight percent of recommendations made to clinicians were accepted while 29% were addressed at a subsequent appointment.

Conclusion:

Integrating MTM home visits at MVNA allowed the pharmacist to conduct thorough medication evaluations, improving medication use and helping to keep patients safely in their homes. Providing services in homes allowed the pharmacist to understand environmental factors affecting a patient’s ability to adhere to a medication regimen. Collaboration between clinicians, home care nurses, and the pharmacist was critical to the implementation of medication changes and therefore, the program’s success.