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Introduction: Home-living older peoples often use many medications and the majority routinely take more than five prescription drugs, and are therefore prone to drug-related problems DRPs. For the management of DRPs, integrated primary care by the homecare, general practice and pharmacy is desired. The Homecare Observation of Medication-related problems by homecare Employees HOME-instrument is paper-based and assists homecare workers in reporting potential DRPs. To facilitate integrated multi professional consultation in primary care a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between homecare and general practices and/or pharmacies is desired. The objective of this study was to develop and evaluate the usability of eHOME, a mobile version of the HOME-instrument consisting of a report, monitoring and consulting system for primary care and to evaluate the type of DRPs revealed by eHOME, integrated care activities and the impact of DRPs on discomfort and clinical deterioration in homecare patients. Theory/Methods: The development phase of the Medical Research Council Framework was followed in which an iterative human-centered design approach was applied. The approach involved a Delphi-round for context of use and user requirements analysis of eHOME, followed by two series of pilots for testing the usability and redesign. The study was performed in 18 homecare teams n18, general practices 7 and pharmacies n10 in several settings in the Netherlands. Subsequently, a pilot study with one-year follow up was carried out in one primary care setting in the Netherlands consisting of 7 home care teams, 7 general practices and 6 pharmacies. Outcomes are: 1 types of DRPs in homecare patients, 2 integrated care activities and 3 classification of the clinical impact of DRPs on patients' discomfort and deterioration unlikely to cause discomfort/clinical deterioration, potential to cause moderate discomfort/clinical deterioration and potential to result in severe discomfort/clinical deterioration. Results: The human-centered design study resulted in eHOME including a report, monitoring and consulting system for the primary care. The results of the pilot study will be expected in May 2018. Conclusion: The eHOME-instrument was found as convenient, clear and easy to use. eHOME can also be used by informal caregivers and professionals caregivers in other settings. Suggestions for future research: Future research on the cost-effectiveness of eHOME in primary care on patient related outcomes e.g. patient satisfaction, quality of life and care related outcomes e.g. changes in care program, consultation moments with the general practitioner, admission to nursing homes and hospitals is needed. [ABSTRACT FROM AUTHOR]

Unlabelled:  , Background: Community pharmacies provide a promising platform for monitoring and improving therapy adherence and providing pharmaceutical care. Structured methods and appropriate software are important tools to increase pharmacist effectiveness and improve health outcomes. In 2006, the Medication Monitoring and Optimization (MeMO) program was introduced in several community pharmacies in the Netherlands. MeMO facilitates targeted and continuous patient-centered pharmaceutical care around chronic medication, such as for osteoporosis, cardiovascular disease, and asthma/chronic obstructive pulmonary disease (COPD)., Objectives: To describe the MeMO program and summarize findings from publications on its effectiveness, patient satisfaction, and cost-effectiveness. , Methods: In the first part of this article, the MeMO program is extensively described. In the second part, a review of the evidence of effectiveness, cost-effectiveness, and patient satisfaction of the MeMO program is provided. Evidence is based on 5 previously published articles., Results: The MeMO program starts with structured counseling sessions with patients at the initiation and follow-up of chronic therapies. This process is followed by a continuous phase in which patients' therapy adherence is monitored on a monthly basis, using standardized search algorithms in the pharmacy database. When the algorithm detects a patient's discontinuation of therapy, tailored interventions are used to improve adherence and optimize pharmacotherapy. For osteoporosis patients, treatment discontinuation with bisphosphonates after 1 year dropped from 31.7% to 16.1% (P  less than  0.001). This program was shown to be cost-effective in patients initiating osteoporotic therapy. Future scenarios with lower drug prices (e.g., from generic prescribing) result in cost savings for the MeMO program. For lipid-lowering drugs, the MeMO program has been shown to lower therapy discontinuation after 1 year from 25.9% to 13.6% (P  less than  0.001). By extrapolating these results to patients' lifetimes, the intervention was estimated to be cost-effective, with gains for primary prevention of cardiovascular events, and even cost saving in secondary prevention. Results from the ongoing MeMO asthma/COPD program are promising, showing marked improvements in therapy control and quality of life for asthma and COPD patients. Almost all patients participating in MeMO programs are satisfied with the pharmacy team and have gained knowledge of the effectiveness and administration of their medications and the importance of therapy adherence., Conclusion: The MeMO program is an effective and structured method to improve patients' adherence to chronic medication in the field of osteoporosis, lipid-lowering drugs, and asthma/COPD and is well received by patients. By targeting the program toward nonadherent and high-risk patients, the program showed favorable cost-effectiveness.

Background: Pharmaceutical care in community pharmacies has been shown to improve adherence to chronic therapies. Long-term impact on clinical outcomes or medical cost savings, however, remains understudied. , Objective: To estimate the cost-effectiveness of a pharmaceutical care intervention program in Dutch community pharmacies that improved patients' adherence to lipid-lowering therapy. , Methods: An economic evaluation was performed using a time-dependent Markov model from the health care payer perspective. Participants were patients initiating lipid-lowering therapy for primary prevention (40%) or secondary prevention (60%) of cardiovascular events (CVEs). The intervention was the pharmaceutical care program MeMO (Medication Monitoring and Optimisation) in 9 community pharmacies in the Netherlands, based on continuous monitoring and optimization of lipid-lowering therapy in new patients. The follow-up period of the program was 1 year. The main outcome of the intervention program was discontinuation of lipid-lowering therapy. This outcome was extrapolated in the economic model to lifelong costs, quality of life, reductions in cardiovascular events, and incremental cost-effectiveness ratios., Results: Patients in the MeMO program had a lower risk for therapy discontinuation, RR = 0.49 (0.37 to 0.66); the effectiveness was similar in primary and secondary prevention. In a cohort of 1,000 primary and secondary prevention patients, the MeMO program resulted in a reduction of 7 nonfatal strokes, 2 fatal strokes, 16 nonfatal myocardial infarctions (MIs), 7 fatal MIs, and 16 revascularizations over patients' lifetime. Additional medication, disease management, and intervention costs in the MeMO program were €411,000; the cost savings due to reduced CVEs were €443,000. The MeMO program resulted in 84 quality-adjusted life-years (QALYs) gained and net cost savings of €32,000. Clinical benefits and cost savings were highest in the secondary prevention population., Conclusion: Pharmaceutical care in community pharmacies can improve statin therapy adherence, resulting in better prevention of CVEs. The MeMO program resulted in considerable clinical benefits and net cost savings. Programs by community pharmacies targeted at improving adherence may provide good value for money, and health care insurers should consider reimbursing these activities.