Feasibility study of the Care-at-Home Pharmacotherapy Service (CAHPS): pharmacy technician-led home visits for people receiving polypharmacy who are housebound living in socioeconomically deprived areas

INTRODUCTION: People who are housebound frequently miss general practice-based long-term condition (LTC) reviews. Missingness from LTC reviews are associated with poorer health outcomes and higher costs. General practice pharmacy collaboration within primary care teams may help address the housebound missingness care gap. AIM: To evaluate the feasibility of implementing the Care-at-Home Pharmacotherapy Service, a general practice pharmacy technician-clinical pharmacist domiciliary review model for housebound patients living in areas of socioeconomic deprivation. METHOD: Pre-post intervention study, in two primary care general practices serving a socioeconomically deprived locality. INCLUSION CRITERIA: adults ≥ 60 years, coded as housebound with ≥ 2 LTCs and ≥ 5 regularly prescribed medications. EXCLUSIONS: adults lacking capacity or receiving palliative care. BASELINE DATA: demographics, Scottish Index of Multiple deprivation (SIMD, a national measure of area-level deprivation), number of regular medications, falls frequency, health-related quality-of-life (EQ5D5L) score, and unscheduled care. Pharmacy technician domiciliary visits involved medication review, adherence support, education and physical assessment. A pharmacist provided clinical supervision and clinical review. Pre-post review outcomes were assessed at 3 months. RESULTS: Twenty-five patients were included (median age 81, range 60-89; 56% female), with 56% living in the most deprived SIMD quintile. In total, twenty-three patients had missed 91 LTC reviews since becoming housebound and were prescribed a median of 14 regular medications (range 9-27). Across 83 encounters with a pharmacy technician, 21 medications were stopped, 19 initiated, and 15 adjusted. Fifteen clinical referrals were generated. Compared with the 3 months before pre-intervention, the total number of self-reported falls during the 3-month follow-up reduced from 8 (range 0-2) to zero (range 0-0). Mean EQ-5D-5L visual analogue score increased from 57 to 62%, and unscheduled care contacts reduced from a total of 56 (range 0-7) to 21 (0-4). CONCLUSION: Pharmacy technician-led domiciliary review with support from a clinical pharmacist is feasible and leads to identification of actionable unmet clinical and medication- needs in older adults who are housebound.