Evaluation of the fleetwood model of long-term care pharmacy.

OBJECTIVES

We sought to evaluate the effectiveness of the Fleetwood Model of pharmacy practice on improving resident outcomes and hypothesized that this model would reduce potentially inappropriate medication use, hospitalizations, and death.

DESIGN

Demonstration project, pre-post design.

SETTING

Twelve nursing homes receiving interventions and 13 homes in the comparison group in North Carolina.

PARTICIPANTS

Residents living in one of the included nursing homes from 2002 to 2004.

INTERVENTION

The Fleetwood Model, performed by dispensing and consultant pharmacists, incorporated prospective reviews, direct communication with the prescribers, and formalized pharmaceutical care planning in patients at highest risk for medication-related problems.

MEASUREMENTS

Hospitalizations because of potential adverse drug events, use of potentially inappropriate medications, mortality.

RESULTS

Residents in the intervention had similar hospitalization rates, hospitalizations owing to potential adverse drug events, and mortality rates as residents in the usual care homes. With respect to the use of potentially inappropriate medications, the decline of use of these medications appeared earlier in the intervention homes relative to the usual care homes, but differences did not reach statistical significance (adjusted Hazard Rate = 0.86; 95% CI: 0.65-1.12).

CONCLUSION

Extending the role of the dispensing and consultant pharmacists beyond federally mandated drug regimen reviews is feasible, although ability to bill and be reimbursed for such services may ensure consistent prospective intervention.