Provision of Clinical Pharmacy Services in the Home to Patients Recently Discharged from Hospital: A Pilot Project
Bibliographic record
Abstract
Background: Home care is an increasingly important component of Canada’s health care system. Despite the array of often-complex medication regimens used in home care, pharmacists have not traditionally been members of home care teams. Also, there is minimal literature describing pharmacist involvement in home care in Canada. Objectives: To determine the rate of identification of medication-related issues by a pharmacist providing home care, the rate of acceptance of the pharmacist’s recommendations and the significance of those recommendations, the types of clinical pharmacy services performed and the resources required to do so, and the satisfaction of patients and the health care team with the services provided by the pharmacist. Methods: Clinical pharmacy services were provided at home to patients who had recently been discharged from hospital and who were at high risk of adverse drug events. Services were provided for at least 3 weeks. Examples of services included comprehensive or focused assessment of the medication regimen, assessment of adverse drug events, and assessment of adherence. The pharmacist kept detailed records of the clinical pharmacy services provided to each patient, which were subsequently analyzed to determine the frequency of particular problems and the outcome of the pharmacist’s recommendations to resolve them. Results: Thirty patients were initially identified, but the analysis is based on the 27 patients (mean age 81.1 years) who received at least one visit from the pharmacist. The mean number of medications per patient was 11.9, the mean number of medication-related issues identified was 3.6, and the mean number of recommendations was 4.3. Of the 53 recommendations made to physicians, 39 (74%) were accepted, and 3 (6%) were rejected; the response to 11 (21%) of the recommendations was unknown. On a scale of 1 to 6, the mean significance of the recommendations was 4.1. Overall satisfaction scores (on a scale from 0 to 10) were 9.6 for health care team members and 9.9 for patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".