Standardizing Hospital Pharmacy Practice in Home Hospitalization: Results from a Multidisciplinary Delphi Consensus in Spain

Beatriz Somoza-Fernández^1,2Ana de Lorenzo-Pinto^1,2Vicente Escudero-Vilaplana^1,2*Silvia Manrique-Rodriguez^1,2Cristina Villanueva-Bueno^1,2María Luisa Martín-Barbero^1,2Carmen Redondo-Galán^1,2Javier Calatayud-García^2,3Víctor González-Ramallo^2,3Ana Herranz-Alonso^1,2María Sanjurjo-Sáez^1,2

• ¹Department of Hospital Pharmacy, Gregorio Marañón Hospital, Madrid, Spain
• ²Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain
• ³Hospital Gregorio Marañón. Unidad de Hospitalización a Domicilio, Madrid, Spain

Introduction The expansion of Home Hospitalization (HH) services has prompted the need for standardized pharmaceutical care models to ensure safe and efficient medication management in the home setting. However, Hospital Pharmacy (HP) departments are often heterogeneously involved in HH programs, and there is a lack of consensus on their roles and responsibilities. The objective was to develop a consensus-based activity dashboard to guide HP departments in implementing standardized pharmaceutical care within HH units in Spain. Methods A modified Delphi method was conducted in five phases: constitution of a coordinating group, definition of candidate activities, selection of a national expert panel, evaluation of the list of activities (two-round consensus process), and analysis of the results. Experts rated the necessity and feasibility of implementing 44 proposed activities by a HP department, using a 9-point Likert scale (in total, 88 items were rated). Activities were included in the final dashboard if ≥75% of panelists rated both dimensions in the 7–9 range. Results Twenty-three multidisciplinary experts participated in the Delphi panel. Consensus was achieved for 60 of 88 evaluated items (68.2%), with 17 activities rated as both necessary and feasible for inclusion in the final dashboard. These activities spanned six domains: drug dispensing, clinical pharmacy care, risk management, communication and patient education, home administration of antineoplastic agents, and clinical research. Several activities were rated as necessary but lacked feasibility consensus, highlighting systemic and resource-based limitations. Conclusion This study provides the first structured consensus on pharmaceutical care activities in HH in Spain, resulting in a practical dashboard to guide HP departments. Its implementation may facilitate the harmonization of care models, optimize medication safety, and support the growing role of pharmacists in home-based care. Addressing feasibility barriers is essential to fully realize the potential of pharmaceutical care in HH programs.