Interprofessional collaboration resolves drug-related problems in home care services in SG

Collaborations among pharmacists, physicians, and nurses in home care results in significant improvements in identifying and resolving drug-related problems (DRPs), a Singapore study has shown.

“By integrating pharmacists as collaborative prescribers, the healthcare team was able to identify and resolve significantly more DRPs,” the researchers said. “Pharmacist collaborative prescribing was safe, with no increase in hospitalization rates.”

A retrospective matched cohort review was conducted using patient case notes from December 2021 to February 2023. Patients in the intervention group received home care service with a collaborative prescribing pharmacist as part of the interprofessional care team, while those in the control group received conventional home care service without a pharmacist.

The researchers used propensity score matching to select control group participants. They assessed effectiveness by comparing the number of DRPs identified and resolved between groups and evaluated safety by comparing all-cause hospitalization rates within 6 months postintervention. Other outcomes assessed were the type of DRPs identified and resolved.

Sixty-nine patients were included in the intervention group and 282 in the control group. More DRPs were identified and resolved in the intervention group than the control group (214 vs 18). Pharmacist collaborative prescribing was not associated with an increase in the rate of hospitalizations. [Proc Singap Healthc 2025;doi:10.1177/20101058251400376]

The most common DRPs were nonadherence (n=91, 43 percent) and the need to optimize drug therapy (n=59, 28 percent) in the intervention group, as well as inappropriate dosing (n=9, 50 percent) and inappropriate drug (n=4, 22 percent) in the control group.

“This study highlights the importance of interprofessional collaboration in home care, demonstrating how pharmacists, nurses, and physicians work together to optimize patient care,” the researchers said. “Scaling this model will require a phased approach, beginning with higher-risk patient groups, coupled with strategies to address manpower, workflow, and funding challenges.”

Home environment

Home visits by pharmacists allowed them to assess the living conditions of patients and subsequently identify potential issues. An earlier study also reported that the home environment has a significant impact on patient behaviours. [Healthcare 2024;12:1723]

Pharmacists reviewed all medications based on the patient’s physical stock during home visits. They were also able to establish a structured daily routine to improve adherence, an approach not typically feasible in hospital settings. [Int J Clin Pharm 2018;40:712-720; Int J Clin Pharm 2018;40:712-720]

“Importantly, pharmacist collaborative prescribing was safe, with no increase in hospitalizations over a 6-month follow-up,” the researchers said.

“This extended timeframe, chosen over the standard 30-day readmission window, allowed for a more accurate assessment of the service’s safety, as the effects of pharmacotherapy optimization typically emerge over a longer duration,” they added.

Notably, these pharmacists worked under collaborative practice agreements, which outlined specific conditions, medications, and treatment guidelines they could manage independently. For complex cases of substantial medication changes, pharmacists consulted physicians, who then reviewed and approved recommendations prior to implementation.

“These findings supported that, with an appropriate framework in place, pharmacist collaborative prescribing was a safe model of care,” the researchers said.