Can community pharmacy successfully bridge the gap in care for housebound patients?

Abstract

Background: There are an increasing number of older housebound patients who are not seen by the pharmacists responsible for the provision of their medications. This growing population is increasingly dependent on time-limited carers for their medication support.

Objectives: To evaluate the findings of pharmacist led holistic domiciliary medicine use reviews (dMUR) targeted at this group of housebound patients, in terms of required medication support and the identification of unmet social care needs.

Methods: Patients were identified in the London Borough of Richmond (UK) who were predominantly housebound and taking multiple medications. Twelve community pharmacists visited patients and carried out interviews as part of a structured holistic dMUR, which included understanding the patients' living conditions.

Results: Altogether 133 patients completed the dMUR with the pharmacist. Patients had a mean age of 81.7 years (range 49-98 years) and took an average of 9.4 different medications, 3 of which being high risk. Nearly 40% had difficulties taking their medications, including a lack of dexterity or difficulty swallowing. Over a quarter (26.8%) of diabetic patients lacked monitoring. Patients were identified with a risk of falling (14.3%) and inadequate social care (11.3%). Continence, dehydration, hygiene and nutrition issues were found, often caused by mobility problems or a lack of suitable toilet facilities. A need for home modifications such as hand rails to prevent falls was also identified.

Conclusions: This study highlighted the varied difficulties facing housebound patients identified during the pharmacists' visits, including a lack of social care provision and fall hazards. Domiciliary visits by pharmacists may be able to help identify the diverse care needs of isolated housebound patients helping to integrate their care requirements.

Keywords: Community pharmacy; Domiciliary care; Medicine review; Older people; Pharmaceutical care.