ORIGINAL RESEARCH
Tasha Woodall, PharmD, BCGP, CPP; Amy Russell, MD; Casey Tak, PhD, MPH; William McLean, MD
Corresponding Author: Casey Tak, PhD, MPH; Department of Pharmacotherapy, College of Pharmacy - University of Utah
Email: casey.tak@hsc.utah.edu
DOI: 10.3122/jabfm.2022.220222R3
Keywords: Clinical Pharmacy Service, Disease Management, Geriatrics, Health Expenditures, Home Care Services, Homebound Persons, Multidisciplinary Care Team, Primary Health Care
Dates: Submitted: 06-23-2022; Revised: 09-01-2022; 10-18-2022; 01-18-2023; Accepted: 01-23-2023
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INTRODUCTION: Home-based primary care (HBPC) has shown promise in the management of multiple chronic conditions for patients who are homebound or who have limited mobility. The objective of this study was to implement and evaluate a HBPC program that integrates the services of clinical pharmacists and community aging services providers in a community-based setting.
METHODS: Mountain Area Health Education Center’s (MAHEC) HBPC program brought together an interdisciplinary team including medical providers, pharmacists, and community aging services providers to conduct home visits with older adults (age 50+). A single-arm, pre-post analysis was conducted to determine differences from the year prior to program enrollment to the year post-enrollment. We examined the frequency of healthcare visits, high-cost healthcare utilization (emergency department [ED] utilization and hospitalizations), and healthcare costs. Descriptive statistics characterized the study population and outcomes. Fisher’s Exact Tests were used to determine if there was a significant difference between years.
RESULTS: There were 130 home visits with 62 patients enrolled in the program. The Medicare Annual Wellness Visit (AWV) was completed for 32 (51.6%) patients. There were 13 (21.0%) and 12 (19.4%) individuals who had at least one ED visit and hospitalization, respectively, pre-enrollment as compared to 8 (12.9%) and 9 (14.5%) individuals post-enrollment (p-value = 0.05, p-value = 0.06). During the post-enrollment year, patient enrollees had an average per-member-per-month (PMPM) cost of $1,567.96 as compared to $3,053.21 in the year prior.
CONCLUSIONS: Pharmacist and community agency services-integrated HBPC was implemented in the community setting. There was a decrease in high-cost healthcare utilization and total healthcare expenditures for patients as compared to the previous year.