Introduction 
Older people are frequently on complicated medication regimes and can have difficulty managing their medicines. Many are housebound and have no contact with a pharmacist. The NSF for Older People highlighted that up to 50% of older people may not be taking their medicine as intended and 5 to 17% of hospital admissions for older people may be due to adverse drug reactions or interactions (DH 2001)¹. The development of pharmaceutical domiciliary visiting services was explored by community pharmacists in the context of the increase in roles undertaken by pharmacists to benefit their patients, including the Medicines Use Review indicated in the new NHS Community Pharmacy Contractual Framework. The work comprised of an examination of the referral process to a pharmacist as well as considering two different models of delivery to discover the range of Medication Related Problems (MRPs) that could be solved with a home visit from a pharmacist. 

Method 
A primary aim of two related studies conducted in neighbouring boroughs (with similar demographics) in London was to compare various MRPs identified at a home visit by the patients own community pharmacist to that of a dedicated domiciliary visiting pharmacist. The study in Borough 1 investigated the use of a dedicated pharmacist and in Borough 2; the patient’s own pharmacist conducted the visit. 

Results 
85 patients were visited by a dedicated pharmacist in Borough 1, with 86 patients visited by one of 14 different community pharmacists in Borough 2. A large range of medication related problems were found at the visits including 15% not taking current prescribed medication, 73% having problems reading or opening containers (compliance related) and having a lack of information about their medicine. Despite 60% of the patients in Borough 2 having a filled compliance aid (box), they were recorded as not able to manage their medication by the pharmacist.

After analysis the dedicated pharmacist was more accurate at noting wrong doses; although all pharmacists had some difficulties in identifying a variety of clinical problems relating to medication, and may benefit from further training. The pharmacists in both studies tended only to note problems concerning medication use such as compliance, understanding of regimen, administration and obtaining supplies. When the data gathered was assessed by an independent clinical pharmacist, a large range of clinical problems had not been identified e.g. drug/drug interactions, incorrect or suboptimal therapy. The pharmacists in Borough 2 tended to fail to record important information concerning the outcome of their visit. 

Conclusions 
The findings indicate that domiciliary visits by community pharmacists can identify patients who could potentially benefit from a review of their medication. Although the pharmacists were able to identify medication usage problems, they were poor at identifying more clinically related aspects of therapy, indicating a need for further training. Little difference was found overall between a dedicated pharmacist and the patient’s own pharmacist, except that the latter were less diligent at recording the outcomes of the visit. 

1. National Service Framework for Older People. Department of Health, March 2001.