Simplifying Medication Regimens for People Receiving Community-Based Home Care Services: Outcomes of a Non-Randomized Pilot and Feasibility Study

Figures & data

Table 1 Baseline Characteristics of Study Participants

	Participants n=25
Age (years) at study entry (mean, ± SD)	79.0 ± 7.5
Male (n, %)	9 (36%)
Self-consent for study participation (n, %)	21 (84%)
Living alone (n, %)	14 (56%)
Type of community-based home care service received (n, %)
Commonwealth Home Support Programme services	15 (60%)
Home Care Packages	10 (40%)
Medical conditions (n,%)
Hypertension	18 (72%)
Hyperlipidemia	16 (64%)
Osteoarthritis	16 (64%)
Ischemic heart disease	9 (36%)
Type 2 diabetes	9 (36%)
Depression	9 (36%)
History of fracture	9 (36%)
Cerebrovascular disease	8 (32%)
Dementia	3 (12%)
FRAIL score^a, median (IQR)	2 (1–3)
Katz Activities of Daily Living scale score, median (IQR)	5 (4–6)
Number of administration times for medications taken regularly (n, %)
Twice daily	13 (52%)
Three times daily	6 (24%)
Four or more times daily	6 (24%)
Total number of medications (mean, ± SD)	13.8 ± 3.9
Medication administration (n, %)
Self-administration	17 (68%)
Receives assistance through community-based home care provider	1 (4%)
Receives assistance from a family member	7 (28%)
Drug Regimen Unassisted Grading Scale (DRUGS) score, median (IQR)
All participants	100 (53.8–100)
Participants who were self-administering medications (n=17)	100 (67.1–100)

Note: ^an=20 participants (weight component of FRAIL score missing for 5 participants).

Abbreviations: DRUGS, Drug Regimen Unassisted Grading Scale; FRAIL, Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight; IQR, interquartile range; SD, standard deviation.

Figure 1 Participant flow chart.

Table 2 Time Spent by the Clinical Pharmacist on Intervention Delivery and Follow-Up

Intervention Components	Time Spent by the Pharmacist (mins), Median (IQR)
Total time spent for home visit	70 (65–75)
Medication reconciliation	55 (45–60)
Administration of the Drug Regimen Unassisted Grading Scale	15 (10–15)
Identifying opportunities for medication simplification	5 (5–10)
Total time spent preparing report	60 (60–70)
Total time spent communicating findings verbally with stakeholders	10 (5–15)

Abbreviation: IQR, interquartile range.

Table 3 Nature and Number of Discrepancies Observed with the Medication List Collected at Baseline from the Participant’s General Medical Practitioner Compared to the Best Possible Medication History (n=24 Participants)^a

Discrepancy Type	No. of Participants with This Type of Discrepancy (n, %)	Total no. of Discrepancies Among all Participants	Proportion of Total Discrepancies (%)
Omission^b	24 (100%)	70	41.7%
Addition^c	20 (83%)	43	25.6%
Dose, frequency or time of administration	20 (83%)	40	23.8%
Route or formulation	6 (25%)	7	4.2%
Generic duplication^d or therapeutic substitution	5 (21%)	7	4.2%
Length of treatment	1 (4%)	1	0.6%

Notes: ^aGP list at baseline not available for one participant. ^bClient taking a medication that is not on the GP medication list. ^cGP medication list contains a medication that the client is not taking. ^dGP medication list contains multiple(s) of the same medication and strength presented as different brand or generic names.

Abbreviation: GP, general medical practitioner.

Table 4 Clinical Significance of Medication Discrepancies Assessed Independently by Two Pharmacists

Significance of Medication Discrepancy	No. of Discrepancies Observed at Baseline (n, %)	Resolved at Follow-Up (n, %)^a	Examples
Unlikely to result in an adverse outcome	93 (55.4)	19/87 (21.8%)	Atorvastatin – GP directions are 1 tablet at night, participant takes 1 in the morning Lubricating eye drops – GP list states three times daily, participant uses as needed Metformin extended release – GP list states 1g twice daily, participant takes 2g daily
Possibly will result in an adverse outcome	39 (23.2)	11/27 (40.7%)	Empagliflozin on GP list, ceased during hospital admission due to declining renal function Paracetamol sustained release not on GP list, participant takes regularly twice daily for osteoarthritis pain Simvastatin listed twice on GP list as two different brand names, may result in unintentional double dosing
Probably will result in an adverse outcome	36 (21.4)	18/30 (60.0%)	Glimepiride on GP list, recently ceased due to a hypoglycaemic episode while driving Short acting insulin not on GP list, participant receives 3 to 10 units with each meal Nebivolol not on GP list, previously commenced by consultant physician
TOTAL	168 (100)	48/144 (33.3%)

Note: ^aData not available for all participants at follow-up.

Abbreviation: GP, general medical practitioner.

Table 5 Comparison of Secondary Outcome Measures at Baseline and Four Months (n=24 Participants Unless Otherwise Stated)

	Baseline	4-Months	p-value
Total no. of medication administration times in 24 hours for regular medications (median, IQR)	2 (2–3)	2 (2–3)	0.092^d
Total no. of individual medication doses in 24 hours for regular medications (median, IQR)	14 (7.3–15.8)	13.25 (7.8–16.5)	0.533^d
Self-Efficacy for Appropriate Medication use Scale (SEAMS) score (median, IQR)^a	38 (32–39)	39 (37–39)	0.145^d
Quality of Life in Alzheimer’s Disease (QoL-AD) score (median, IQR)	36 (33.5–37.5)	36.5 (32–38.5)	0.509^d
Short Assessment of Patient Satisfaction (SAPS) score (mean, SD)^b	22.5 ± 3.0	21.5 ± 3.2	0.278^e
Participant self-reported receiving a Home Medicines Review (n, %)	1 (4.2)^c	2 (8.3)	1.000^f
Participant self-reported one or more falls (n, %)	7 (29.2)^c	5 (20.8)	0.480^f
Participant self-reported one or more ambulance call outs with transportation (n, %)^a	6 (26.1)^c	3 (13.0)	0.180^f
Participant self-reported an emergency department visit (n, %)	5 (20.8)^c	1 (4.2%)	0.103^f
Participant self-reported a hospitalization (n, %)	4 (16.7)^c	2 (8.3)	0.317^f
Participant self-reported an emergency department visit or hospitalization (n, %)	8 (33.3)^c	3 (12.5%)	0.096^f
Participant self-reported respite admission (n, %)	0 (0.0)^c	1 (4.2%)	N/A

Notes: ^an=23 participants. ^bn=22 participants. ^cOutcomes experienced in the four months prior to study entry. ^dWilcoxon signed-rank test. ^ePaired t-test. ^fMcNemar’s test.

Abbreviations: IQR, interquartile range; N/A, not applicable; QoL-AD, Quality of Life in Alzheimer’s Disease; SAPS, Short Assessment of Patient Satisfaction; SEAMS, Self-Efficacy for Appropriate Medication Use Scale.