A report published in the Archives of Internal Medicine and calling for establishment of a "pharmacy home" model of care is generating comments from HDM readers.

A pharmacy home, similar to a medical home model, could better coordinate medication therapies for chronically ill patients with many prescriptions, according researchers at Harvard Medical School and Brigham and Women's Hospital in Boston (see story).

One reader believes that skilled nurses in home care settings already provide the coordination of medication therapies called for in a pharmacy home:

"A medication review is one of the items covered in a skilled nursing visit and we are by regulation required to review the client's medications. I do think home health care is sometimes excluded from the continuum of care.

"Additionally, I do believe the payors who are receiving the information as to what has been charged to the client could do a better job in this area by performing quality control in what is dispensed.

"It is interesting having made home visits, what is in some folks medicine cabinets or boxes--duplicate drugs, old prescriptions, etc."

Robert DeFazio, CEO at Calabria Consulting in Dunlap, Tenn., is quite skeptical that the pharmacy home model will catch on:

"For decades the Physicians Desk Reference sat on the desks of doctors, and never once did I see any of my personal physicians open it in my presence.  The motivation behind the publication of this tome was to provide information about the purpose, side effects, and dosage for medications as well as contraindications and potential conflicts with other medications that physicians should know before prescribing.  Implicit in all this was the notion that patients would generally be under the care of one or a small group of physicians who would talk with each other to come up with a plan for treatment and medication management.

"Typically enough, that usually never happens.  Patients shop doctors, or primary physicians refer patients to specialists, and the feedback from one medical professional to another is limited.  The result is that patients are left to figure things out for themselves.  When they get into trouble, that's when the doctors put their heads together.

"Only today has the medical profession decided that it needs to track medications more accurately, to create portable electronic records of a patient's health history, to farm the information from electronic health records to provide greater insight into disease management, or to produce a medication management program that is coordinated between all the doctors who prescribe medication for a patient.  Even now, the real reason that the profession has suddenly gotten the technology religion is that the government has dictated that it must occur ... or else.

"In large measure this embarrassing condition has been aided by the sole practitioner frame of mind where each doctor decides what works for him without much regard for what works for the patient who must deal with other physicians.  This kind of deference to the private physician will continue to yield a profession that is always ten steps behind the rest of the world when it comes to using the full capabilities of technology unless the medical profession as a whole reaches a point at which it acknowledges that some of the things it does should be governed by someone other than a physician."

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