Why Home-Based Care Agencies Need Pharmacists That Are ‘In The Loop’

It takes a village to build and maintain a successful at-home care program for seniors aging in place.

As more care expands into the home, a pharmacist’s role in that village is only going to get more necessary.

“Hospitals typically provide patients with a medication reconciliation sheet upon discharge, but there’s often a discrepancy between the medications listed on this sheet and what the patient is actually taking,” Mary McPherson, professor and executive director of the advanced post-graduate education in palliative care program at the University of Maryland School of Pharmacy, told Home Health Care News. “This gap can lead to errors in the medication regimen when patients transition to home care. To address this issue, it’s crucial for home care providers to conduct thorough medication reconciliation upon admission and to follow up within a week to ensure accuracy.”


Ensuring accurate medication management in home care involves more than just reviewing a client’s reconciliation sheet, McPherson said. It requires asking probing questions to uncover any overlooked or omitted medications and conducting a comprehensive medication review with patients.

Involving pharmacists as part of the care coordination team in home care is a valuable addition, and something more providers should consider, McPherson believes.

That’s especially the case as patients continue to be more complex and receive more acute levels of care in the home.


“I think one of the biggest issues is polypharmacy,” McPherson said. “Which is essentially when someone routinely takes five or more medications a day. Some patients are taking up to 25 medications daily, often in multiple doses. It’s impossible to keep them all straight. The more medications a patient has, the higher the risk of an adverse effect or a drug interaction. Whether it’s a home care or hospice patient, it’s really important to have goal-concordant prescribing.”

In other words, the prescribing should be aligned with a patient’s goals.

Pharmacists can also identify drug-related problems that frequently arise in home care settings.

These problems include drug use without indication, inappropriate drug selection, need for additional drug therapy, overdose, underdose and adverse effects, among others. Pharmacists play a key educational role in the care continuum and should be utilized to the best of their abilities.

“The pharmacist is the most readily accessed health care provider of all because you can walk into the pharmacy and it’s free,” McPherson said. “The pharmacist has the most face-to-face time with patients, families and caregivers. I think pharmacists have a huge role to play in educating people.”

Involving pharmacists in the care team can also provide valuable support through their availability for questions, participation in team meetings and helping with staff education and patient materials.

These practices can improve medication management and reduce the risk of errors during transitions of care in home settings, McPherson said.

“Overall, there’s a significant need for education and support for patients, families and caregivers to navigate the complexities of medication management and ensure the best possible outcomes,” McPherson said. “I do think it’s important that home care agencies, hospice agencies and other post-acute providers should always have a pharmacist in the loop.”

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