Implementation and Evaluation of a Long term Care at Home (Home LTC) Service in a Rural Community Pharmacy Setting.

Background: The majority of older Americans are expected to need some level of institutional long term care. Community pharmacies are positioned to delay this need by supporting medication management. There are potential mechanisms for pharmacists to deliver long term care at home (Home LTC) services and bill insurers for services that may delay the transition to a higher level of care. Objectives: This project aims to evaluate the implementation of a community pharmacy delivered Home LTC service in a rural community. The objectives were to: 1) describe implementation and challenges of pharmacy-provided HOME LTC services, 2) attempt billing for Home LTC services, 3) describe pharmacist clinical interventions including drug therapy problems (DTPs) and 4) measure patient/caregiver satisfaction with the service. Methods: This was a pilot evaluation of a community pharmacist delivered intervention. Patient eligibility requirements include taking 6+ medications, having 3+ chronic conditions, and having 2+ limitations in activities of daily living (ADLs). All participants received a comprehensive medication review. Pharmacy staff prepared medications in monthly adherence packaging and delivery was offered. Home visits were performed by the pharmacist as needed. A post study survey assessed satisfaction and invited suggestions for improvement. Patient characteristics, DTPs, interventions, reimbursement attempts and amounts, and survey responses were documented, and analyzed descriptively. Results: Fourteen patients were enrolled in the study - 3 living in a group home and 7 were already receiving adherence packaging. All 14 patients received at least 1 clinical intervention, and 4 home visits were conducted. Seven patients (50%) completed the satisfaction survey and reported universally high satisfaction with the service elements. Conclusion: Overall, implementing a HOME LTC service was successful, however, the pharmacy failed to be reimbursed for service elements, including adherence packaging. Patients were satisfied with the service. Bridging the reimbursement gap is critical to sustainably provide patients with this desired service.