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Health Services Research & Development

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In this issue: Advancing VA Telehealth and Virtual Care
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June 2021

Medication Management at Home Via Pharmacy Home Tele-Visits

Takeaway: Through pharmacist-led home video tele-visits, this study is expected to lead to the reduced use of potentially inappropriate medication – and medication discrepancies among older Veterans, as well as increased medication adherence and reduced adverse drug events.

Older adults are more likely to suffer from multiple chronic conditions, to be prescribed multiple medications, and are more susceptible to the adverse effects of medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimen. Complex medication regimens are potentially harmful to older adults due to potential drug interactions, potentially inappropriate prescribing or over-the-counter drug use, and medication non-adherence that may lead to poor control of chronic disease. Clinical pharmacist-led interventions to improve appropriate medication use in older adults, including the application of the STOPP (Screening Tool for Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria, have demonstrated effectiveness in reducing adverse drug events. With the increased capability of VA telemedicine to reach Veterans in their homes, delivering medication management via tele-visit by clinical pharmacists has the potential to yield similar benefits for a larger number of older Veterans.

This ongoing study (May 2020 – April 2024) seeks to examine the effect of medication management by clinical pharmacists via home video tele-visits, as home video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Investigators in this study are working to develop a protocol for pharmacy home tele-visits for older Veterans who have multiple chronic conditions and are on multiple medications. They will then conduct a randomized trial to examine the effect of these tele-visits on appropriate medication use, medication discrepancies, adherence, and adverse drug events – and to observe and gather information on implementation. They also will evaluate the barriers and facilitators to implementing the intervention so that study findings may inform future implementation.

Methodology

As part of this study, investigators will conduct a randomized trial with a hybrid effectiveness Type I design to examine the effect of tele-visits on appropriate medication use, medication discrepancies, adherence, and adverse drug events.

Findings

A total of 12 video visits by pharmacists were conducted in the home, which were observed directly by the research team. Challenges in the use of video at home by Veterans were observed, including a lack of comfort with technology use, as well as difficulty with access to email and equipment. However, it is feasible for Veterans to show pharmacists how medications were stored, to retrieve both prescribed and non-prescribed medications or supplements, and demonstrate their use of medications. These observations will lead to an adaptation in the protocol on coaching Veterans how to set up and conduct tele-visits to review medication use.

Anticipated Impact

This pharmacist-led medication management home tele-visit intervention is expected to result in a reduction in the use of potentially inappropriate medication – and medication discrepancies among older Veterans, as well as increased medication adherence and reduced adverse drug events.

Principal Investigators

William Hung, MD, MPH, is part of the James J. Peters VA Medical Center in Bronx, NY, and Lauren Moo, MD, is part of HSR&D’s Center for Healthcare Organization & Implementation Research (CHOIR) in Bedford and Boston, MA.

Publications

No publications to report thus far

View study abstract

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