Establishing Interprofessional Medication Reviews in Home Care Patients – A Feasibility Study

Carla Meyer-Massetti,1,2 Anita Sommer,1 Estelle Kaiser,1 Anna Maria Peschak,3 Marina Preisig,4 Carole Elodie Aubert,1,5 Raphael Dimitri Mäder,1 Lisa Ramseier,2 Irene Stefanie Riesen,2 Stefanie Lettieri-Amstutz,2 Daniela Rölli,2 Nicole Schönenberger,6,7 Christoph R Meier1,8 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; 2Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; 3Spitex Bern, Bern, Switzerland; 4Spitex Stadt Luzern, Lucerne, Switzerland; 5Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland; 6Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital - University Hospital Bern, Bern, Switzerland; 7Graduate School for Health Sciences, University of Bern, Bern, Switzerland; 8Hospital Pharmacy, University Hospital of Basel, Basel, SwitzerlandCorrespondence: Carla Meyer-Massetti, University of Bern, Institute for Primary Health Care BIHAM, Mittelstrasse 43, Bern, CH-3012, Switzerland, Email [email protected]: Medication-related problems are especially frequent among home-care patients, who are predominantly older, multimorbid, polymedicated and interact with multiple professionals, necessitating timely, complete and accurate drug information communication.Aim: To pilot a standardised approach to interprofessional home-care medication management focusing on deprescribing.Methods: Home-care patients, cared for in their own homes by one professional nursing agency in the city of Bern, Switzerland, aged ≥ 64 and taking ≥ 4 prescribed medications were assessed for medication-related risk with the interprofessional, 10-item doMESTIC RISK tool. Community pharmacists performed structured medication reviews for at-risk patients, communicating with primary care physicians via standardised form.Results: Nurses initiated 106 risk analyses (as defined in the process) in consenting patients, with 76 (72%) completed by pharmacists; 30 analyses could not be completed due to missing information. Out of 76 patients with a completed risk assessment, 26 patients did not need a medication review; one score was missing. The 49 patients qualifying for a medication review were on average 84.0 ± 7.7 years old and took a mean of 11.2 ± 4.5 prescribed medications regularly and 2.8 ± 3.5 prescribed as-needed medications. Pharmacists identified a median of two problems per patient, suggesting 64 potential interventions. Forty-three priority interventions for 18 patients were communicated to physicians, mostly dose reduction (27%) and therapy cessation (23%). Despite providing comprehensive information in the requests, physicians only reacted to 50% of pharmacists’ recommendations (9/18 patients), accepting 57% of pharmacists suggestions in nine patients, predominantly deprescribing (nine medications).Conclusion: While pharmacists identified medication improvements through structured medication reviews, limited access to clinical information and insufficient communication between health care professionals were key barriers. Strengthening interprofessional collaboration and structured communication through shared platforms allowing clinical data exchange is essential to optimizing medication management in home-care. Clarification of the roles of the team members must be improved.Keywords: medication safety, polypharmacy, potentially inappropriate medication, home care, interprofessional collaboration, medication review