Effect of pharmaceutical care services on outcomes forh.ome care patients with heart failure

Purpose. The effect of pharmaceutical care services for home care patients with heart failure on death and rehospitalization rates was studied. Methods. Eligible patients had to be at least 21 years old and included those with a primary or secondary diagnosis of heart failure who were referred to receive skilled nursing services. Patients were then randomized to receive usual care or pharmaceutical care. Patients assigned to the usual care group received the services typically provided by the visiting nurses association, while patients in the pharmaceutical care group received usual care plus standardized services from a clinical pharmacist. Pharmaceutical care services consisted of an initial comprehensive inhome medication assessment and two follow-up visits. Throughout the three-week intervention period, the clinical pharmacist accessed and reviewed all pertinent physician notes and laboratory test values and interacted with prescribers on behalf of the patients as necessary. Results. A total of 154 patients met all criteria and participated in the study. The pharmacist made 79 specific therapy recommendations, 47 (60%) of which were related directly to drug therapy for heart failure or cardiovascular disease. Overall, 14 therapy recommendations were fully implemented, and 10 heart failure-specific recommendations were fully implemented. Patients for whom the pharmacist had made recommendations that were followed by the prescriber had a reduced rate of the composite primary endpoint, but this difference did not reach statistical significance. Conclusion. A home-based pharmaceutical care model for recently hospitalized patients with heart failure did not significantly improve the combined rate of death or rehospitalization.