Can community pharmacy successfully bridge the gap in care for housebound patients?

BACKGROUND: There are an increasing number of older housebound patients who are not seen by the pharmacists responsible for the provision of their medications. This growing population is increasingly dependent on time-limited carers for their medication support. OBJECTIVES: To evaluate the findings of pharmacist led holistic domiciliary medicine use reviews (dMUR) targeted at this group of housebound patients, in terms of required medication support and the identification of unmet social care needs. METHODS: Patients were identified in the London Borough of Richmond (UK) who were predominantly housebound and taking multiple medications. Twelve community pharmacists visited patients and carried out interviews as part of a structured holistic dMUR, which included understanding the patients' living conditions. RESULTS: Altogether 133 patients completed the dMUR with the pharmacist. Patients had a mean age of 81.7 years (range 49-98 years) and took an average of 9.4 different medications, 3 of which being high risk. Nearly 40% had difficulties taking their medications, including a lack of dexterity or difficulty swallowing. Over a quarter (26.8%) of diabetic patients lacked monitoring. Patients were identified with a risk of falling (14.3%) and inadequate social care (11.3%). Continence, dehydration, hygiene and nutrition issues were found, often caused by mobility problems or a lack of suitable toilet facilities. A need for home modifications such as hand rails to prevent falls was also identified. CONCLUSIONS: This study highlighted the varied difficulties facing housebound patients identified during the pharmacists' visits, including a lack of social care provision and fall hazards. Domiciliary visits by pharmacists may be able to help identify the diverse care needs of isolated housebound patients helping to integrate their care requirements.

Fragilidad, el nuevo paradigma de atención sanitaria a los mayores / Frailty: The new paradigm of health care in the elderly

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An evaluation by elderly people living at home of the prepared meals distributed by their municipality - a study with focus on the Swedish context.

Prepared meals distributed by municipalities is a service to elderly people, or persons with health related impairments, who live in their own home, have difficulties preparing their own food and cannot meet their food requirements in any other way. This study aimed to provide a brief picture of how elderly people living at home perceive the food they receive through their municipal food service and what is important to them. The data was collected using questionnaires. 274 out of 276 participants answered the questionnaire (n=173 women 62% and n=101 man 37%). The data was analyzed using Principal Component Analysis (PCA). The results showed that the elderly persons receiving meals through the service were often satisfied, especially with the size of the portions and the delivery time. Those who had been using the food delivery service for a longer time were not satisfied with the alternative dishes they were been offered. There was no significant difference between the views of either gender. Further, those who were receiving special food were, in general, unsatisfied with the meals delivered. Development of the food distribution service by systematic quality insurance and interactive knowledge exchange between the producers and consumers seems to be a way to promote a more holistic and individual adjusted service. Evaluation of the municipal FD service is a powerful tool that can contribute to the development of this service. The food service can be improved and consequently even the quality of life and health of its receivers. The present survey should be revisited and developed in order to detect differences between genders.

Evolución de la nutrición enteral domiciliaria en Madrid 2002-2007 / Evolution of home-based enteral nutrition in Madrid 2002-2007

Introducción: La Nutrición Enteral Domiciliaria en Madrid utiliza como soporte la receta oficial lo que facilita el uso de sistemas de información para el análisis de su consumo y evolución. Objetivos: Análisis cualitativo y cuantitativo de la evolución del consumo de NED de 2002 a 2007. Tendencia e identificación de los productos con mayor impacto en el periodo 2006-2007. Características de los pacientes. Métodos: Selección de recetas facturadas de productos de NED, clasificación por tipos y análisis de la evolución en importe y en envases para el periodo 2002 -2007. Estudio de la evolución consumo 2006-2007 identificando los productos con mayor impacto, la distribución de su prescripción y las características de los pacientes a los que se indica. Resultados: En el periodo 2002-2007, los envases han aumentado más del doble y el importe económico se ha triplicado, observándose un desplazamiento hacia las dietas completas hiperproteicas. El análisis 2006-2007 de las mismas nos lleva a identificar 5 productos cuyo incremento en envases ha superado el 210%. La edad media de los pacientes es 60,33 años, siendo los diagnósticos más frecuentes oncológicos y neurológicos. El 69% de los tratamientos están prescritos como suplementos a una dieta de consumo ordinario. Discusión: En los últimos 6 años se evidencia la tendencia al alza y el desplazamiento hacia dietas del tipo completas hiperproteicas que suponen ya en 2007 casi la tercera parte del consumo. Dos terceras partes de los tratamientos están dirigidos a pacientes geriátricos con patologías oncológicas o degenerativas del sistema nervioso central (AU)

Introduction: Home-based enteral nutrition in Madrid uses the official prescription form which facilitates the use of information systems for analysing consumption and evolution. Objectives: Qualitative and quantitative analysis of the evolution of HBEN use from 2002 to 2007. Trend and identification of the products with higher impact for the period 2006-2007. Patients characteristics. Methods: Selection of invoiced prescriptions of HBEN products, classification by type, and analysis of price and pack number evolution for the period 2002 -2007. Study of the consumption evolution 2006-2007 identifying those products with higher impact, the prescription distribution, and the characteristics of the patients in whom HBEN is prescribed. Results: In the period 2002-2007, the number of packs has increased more than twice and the costs have tripled, observing a shift towards complete hyperproteinic diets. When analysing these diets in the period 2006-2007, there are five products that have increased the number of packs by more than 210%. The mean patients age was 60.33 years. The most frequent diagnoses were oncologic and neurologic. 69% of the treatments are prescribed as dietary supplements for an ordinary diet. Discussion: For the last 6 years, an increasing trend is observed as well as a shift towards complete hyperproteinic diets, which in 2007 accounted for almost a third of the whole consumption. Two thirds of the therapies are focused on geriatric patients with oncologic or central nervous system degenerative pathologies (AU)

Multivitamin use and B vitamin status in a homebound elderly population.

OBJECTIVE: Homebound elderly are at increased risk for micronutrient deficiencies and nutritional status in this population has not been adequately described. There is evidence for beneficial effects of multivitamin use and a greater understanding of their nutritional contribution could identify behaviors that may help alleviate excess chronic disease. The purpose of this analysis is to investigate, in a racially diverse group of homebound elders, the association of multivitamin use with measures of plasma B vitamin concentrations. DESIGN: We examined the cross-sectional association between multivitamin use and plasma concentrations of B vitamins and homocysteine in 236 white and 182 black homebound elders (65-99y). Dietary intake was assessed and demographic and health information was ascertained. RESULTS: White and black elders had a high prevalence of dietary intakes below the Estimated Average Requirement for folate (38.1 and 40.7%), vitamin B6 (16.9 and 19.2%.), and vitamin B12 (3 and 3.9%) respectively. Multivitamin use was associated with higher mean plasma B vitamin concentrations in each group. In whites, multivitamin users had higher concentrations of vitamin B6 (64.6 vs. 32.4 nmol/L; p < 0.001), vitamin B12 (398 vs. 324 pmol/L;p < 0.001) and folate (39.4 vs. 30.4 nmol/L;p < 0.001). Black multivitamin users had higher concentrations of vitamin B6 (53.7 vs. 29.5 nmol/L; p < 0.001), B12 (427 vs. 372 pmol/L; p < 0.05) and folate (35.7 vs. 25.4 nmol/L; < 0.001) than non-users. CONCLUSIONS: Multivitamin supplementation was associated with higher mean plasma concentrations of vitamins B6, B12, and folate and lower prevalence of low plasma B vitamin status in a biracial homebound elderly.

Patterns of complementary therapy use by homebound cancer patients in Taiwan.

This study explores the use of complementary therapy and factors associated with the use of such therapies by cancer patients in Taiwan who were receiving surgery, chemotherapy, or radiotherapy and lived at home. Data were collected by purposive sampling and analyzed by chi-square testing. Subjects (N = 137) from two Taipei area hospital-based oncology centers were interviewed by using a structured questionnaire. Sixty percent of the total sample used complementary therapies. Variables, such as gender, duration of illness, diagnostic stages, chemotherapy, and symptoms distress, were significantly (p <.05) related to the use of complementary therapies. Western health professionals need to know what complementary therapies their clients are using so that they can respond appropriately to questions raised by their clients, as well as help them to acknowledge diverse kinds of treatment in their therapeutic plans.