A new research study by a five-member team of pharmacists may help more patients achieve enhanced outcomes by using their prescription meds more effectively.
By Jack Kohane
Photography by Brandon Gray
Funded by a grant from the Canadian Foundation for Pharmacy, the anticipated eight-month-long study, spearheaded by award-winning pharmacist John Papastergiou, aims to uncover the major medication management issues in the homes of ambulatory patients. “Pharmacists are well positioned to make sure all of their patients are not using expired or discontinued medications, misusing weekly compliance packages, or mixing the wrong drugs,” says Papastergiou from his Shoppers Drug Mart store in downtown Toronto.
For homebound patients, the current MedChecks at Home Program (introduced in Ontario in 2010) allows community pharmacists to work with the hardest-to-reach members of the community. “These reviews have shown to be an effective means of identifying and resolving meds usage problems,” Papastergiou points out.
But based on anecdotal evidence from daily practice, he hypothesizes that many non-homebound patients may also be affected by similar medication management issues. “As community pharmacists working in busy dispensaries, we recognize that there are many opportunities out there to deliver quality of care for our chronic patients. These are the people who need some extra help,” he says. “But what we usually don’t have is a clear picture of the patient’s home environment, and how they are taking their drugs when there. This is something we need to know to ensure those patients understand their prescriptions and take them properly.”
A graduate of the Leslie Dan Faculty of Pharmacy (University of Toronto in 2002), Papastergiou was awarded the OPA Mentorship Award (2014) and named Canadian Pharmacist of the Year. He is already recognized for his innovative home-based medication review program for his pharmacy’s homebound patients. It’s no surprise then that he’s now also focusing on those who are able to walk into his store. He notes that the objectives of the study are to investigate the prevalence and characterize the nature of these “hidden in the home” mediation management issues among non-homebound patients, and to develop a set of criteria to help pharmacists identify which non-homebound patients may stand to benefit most from a home-based medication review.
How the study works
Pharmacists involved in this research initiative have been chosen to represent communities with a diverse, mixed demographic patient population. “Each of us will visit the homes of 20 of our patients (candidates are selected using a telephone-based pre-screening interview consisting of five questions pertaining to prescriptions and how they are being used), for a total of 100 home visits for the team,” Papastergiou explains.
Key metrics will be recorded during medication reviews and will include the number and types of drug therapy problems identified, detailed notes on patient medication management, organization and storage practices, and the number and nature of expired, discontinued or duplicated medications found in the home. Papastergiou anticipates that preliminary findings will be available early this year. “The pace of the study will of course depend on how many homes we visit over the course of the next few months,” he says.
Analysis will then involve an assessment of the value of home medication reviews for the selected patients based on the prevalence and level of risk associated with medication management issues detected in the home. The results of this study, according to Papastergiou, will contribute to supporting the larger, long-term goal of redefining eligibility criteria for publicly funded home-based medication review programs in order to improve access and maximize clinical benefits for patients who are most in need of these services.
“On completion of the study, we hope to publish results of the study in the Canadian Pharmacist Journal (published by CPhA) or equivalent,” says Papastergiou. “Ideally, the results will be of interest to pharmacists and pharmacy stakeholders. Results should provide insight into how a pre-screening process can help identify candidates who may benefit from home-medication review.” He is quick to add that he looks forward to seeing the final results.