Introduction
The objectives that can be achieved by the pharmacist during a domiciliary visit include improvements in patient's knowledge, compliance and drug storage, reductions in adverse drug reactions and number of GP consultations, and optimisation of the patient's drug regime. ^1,2,3 Domiciliary visiting also provides an opportunity for the pharmacist to simplify a patient's drug regimen and/or achieve a reduction in the cost of prescribed medicines. The aim of this study was to assess the quantitative changes in the number and total costs of prescribed medication including unused medicines as one of the outcome measures of a domiciliary care intervention by community pharmacists to elderly housebound patients.

Method
Pharmacists were recruited and trained to carry out domiciliary visits to elderly housebound patients. The study was carried out with the full knowledge and co-operation of the patient's GP. Suitable patients were identified and recruited by either the pharmacist or GP according to agreed criteria. Before the first domiciliary visit, a researcher carried out a baseline assessment visit during which all details of medicines present at the time of interview were noted. Each patient's pharmacist carried out a medication review prior to the domiciliary visit. Patients subsequently received 1-3 visits or a follow-up telephone call over the six month study period according to the complexity of their medication management problems. The assessments performed at baseline were repeated at the end of the study. All data were entered into SPSS for analysis and statistical significance determined using the Wilcoxon Signed Ranks Test.

Results
The final study population was 81 patients who were regular customers of one of the 15 pharmacists in the study. The mean age of participants was 80 years (range 65-94). The majority of participants were female (72%).

The number of items of medicine taken by each patient was significantly reduced (P=0.036) following the domiciliary pharmaceutical intervention with 44 (54%) patients taking a fewer number of drugs. The mean number of daily doses was reduced and approached significant levels (P=0.054) with 22 (27%) patients taking fewer doses. The total cost of all drugs taken by each patient calculated for a 28 day period (approximately �55) showed little change after the pharmacist domiciliary intervention. There was a significant reduction in the number (P=0.002) and total cost (P=0.002) of unused drugs stored in the patient's home. Generic prescribing of medicines had also increased significantly (P=0.012) after the domiciliary care intervention.

Discussion
The results of the present study show that it was possible to simplify the prescribed drug regimen. It was also possible to achieve cost savings through reducing the numbers of unused medicines. However, total drug costs of medicines that the patient was currently taking were not reduced despite the significant increase in generic prescribing of medicines. This indicates that changes made were not sufficient to reduce costs and/or involved a switch to similarly priced or more expensive medicines. In conclusion, a domiciliary pharmaceutical care programme can make a positive impact on patient medication management.

References

1. Begley S, Livingstone C, Hodges N, Williamson V. (1997) Impact of domiciliary pharmacy visits on medication management in an elderly population. The International Journal of Pharmacy Practice, 5, 111-121
2. Read RW, Krska J. (1998) Targeted medication review: patients in the community with chronic pain. The International Journal of Pharmacy Practice, 6, 216-22t
3. Schneider J, Barber N. (1996) Provision of a domiciliary service by community pharmacists. The International Journal of Pharmacy Practice, 4, 19-24