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Lüthold RV, Cateau D, Jenkinson SP, Streit S, Jungo KT. Pharmacists' attitudes towards interprofessional collaboration to optimise medication use in older patients in Switzerland: a survey study. BMC Health Serv Res 2024; 24:849. [PMID: 39061037 PMCID: PMC11282592 DOI: 10.1186/s12913-024-11339-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Collaboration between physicians and pharmacists facilitates the conduct of medication optimisation efforts. In the context of deprescribing, pharmacists' roles are often described as making deprescribing recommendations to physicians. Little is known about factors associated with pharmacists' willingness to make deprescribing recommendations and their interprofessional collaboration with physicians in Swiss primary care settings. OBJECTIVE To explore pharmacists' perspectives on medication optimisation and deprescribing in older adults, and their preferences for interprofessional collaboration in Swiss primary care settings. METHODS In this cross-sectional study, a random sample of 1000 pharmacist members of the Swiss Pharmacists Association pharmaSuisse was invited to participate in a survey on medication optimisation, deprescribing, and interprofessional collaboration. The survey contained three case vignettes of multimorbid patients with polypharmacy aged ≥ 80 years old, with different levels of dependency in activities in daily living (ADL) and cardiovascular disease (CVD). For each case vignette, pharmacists were asked if and which medications they would deprescribe. We calculated proportions of pharmacists' willingness to deprescribe by case vignette and performed a multilevel logistic regression to assess associations between CVD, ADL, and willingness to deprescribe. RESULTS One hundred thirty-eight (14%) pharmacists responded to the survey: 113 (82%) were female, their mean age was 44 years (SD = 11), and 66% (n = 77) reported having never received any specific training on how to conduct structured medication reviews. Eighty-three (72%) pharmacists reported to be confident in identifying deprescribing opportunities. All pharmacists were willing to deprescribe ≥ 1 medication in all vignettes. Patients with CVD were at lower odds of having medications deprescribed (OR = 0.27, 95%CI 0.21 to 0.36). Willingness to deprescribe was lower with higher dependency in ADL (medium versus low dependency: OR = 0.68, 95%CI 0.54 to 0.87, high versus low dependency: OR = 0.72, 95%CI 0.56 to 0.91). However, the effect of dependency in ADL on willingness to deprescribe was significantly modified by the history of CVD. One hundred five pharmacists (97%) reported to interact with physicians to clarify questions regarding prescriptions at least once a week and 88 (81%) wished to be more involved in deprescribing and medication review. CONCLUSION Pharmacists were willing to make deprescribing suggestions for older patients with polypharmacy, but two-thirds reported having received no formal training on how to perform structured medication reviews. Pharmacists would like to be more involved in the process of medication review and deprescribing, which should be leveraged in the context of Swiss primary care settings.
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Affiliation(s)
- Renata Vidonscky Lüthold
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Damien Cateau
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1015, Lausanne, Switzerland
| | - Stephen Philip Jenkinson
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1015, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland
| | - Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, 3012, Bern, Switzerland.
- Division of Pharmacoepidemiology and Pharmacoeconomics and Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 02115, MA, Boston, USA.
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Bennetts J, White J, Croft H, Cooper J, McIvor D, Eadie N, Appay M, Sverdlov AL, Ngo D. Pharmacist-led medication management services: a qualitative exploration of transition-of-care cardiovascular disease patient experiences. BMJ Open 2024; 14:e082228. [PMID: 38777587 PMCID: PMC11116877 DOI: 10.1136/bmjopen-2023-082228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Hospitalisation due to medication-related problems is a major health concern, particularly for those with pre-existing, or those at high risk of developing cardiovascular disease (CVD). Postdischarge medication reviews (PDMRs) may form a core component of reducing hospital readmissions due to medication-related problems. This study aimed to explore postdischarge CVD patients' perspectives of, and experiences with, pharmacist-led medication management services. A secondary aim explored attitudes towards the availability of PDMRs. DESIGN An interpretative qualitative study involving 16 semistructured interviews. Data were analysed using an inductive thematic approach. SETTING Patients with CVD discharged to a community setting from the John Hunter Hospital, an 820-bed tertiary referral hospital based in New South Wales, Australia. PARTICIPANTS Patients with pre-existing or newly diagnosed CVD who were recently discharged from the hospital. RESULTS A total of 16 interviews were conducted to reach thematic saturation. Nine participants (56%) were male. The mean age of participants was 57.5 (±13.2) years. Three emergent themes were identified: (1) poor medication understanding impacts transition from the hospital to home; (2) factors influencing medication concordance following discharge and (3) perceived benefits of routine PDMRs. CONCLUSIONS There is a clear need to further improve the quality use of medicines and health literacy of transition-of-care patients with CVD. Our findings indicate that the engagement of transition-of-care patients with CVD with pharmacist-led medication management services is minimal. Pharmacists are suitable to provide essential and tailored medication review services to patients with CVD as part of a multidisciplinary healthcare team. The implementation of routine, pharmacist-led PDMRs may be a feasible means of providing patients with access to health education following their transition from hospital back to community, improving their health literacy and reducing rehospitalisations due to medication-related issues.
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Affiliation(s)
- Joshua Bennetts
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jennifer White
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Hayley Croft
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Joyce Cooper
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Dawn McIvor
- College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Cardiovascular Department, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Nicholas Eadie
- Department of Pharmacy, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Marcelle Appay
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Pharmacy, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Aaron L Sverdlov
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Cardiovascular Department, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Doan Ngo
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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3
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Lee K, Kouladjian O'Donnell L, Cross AJ, Hawthorne D, Page AT. Clinical pharmacists' reported approaches and processes for undertaking Home Medicines Review services: A national survey. Arch Gerontol Geriatr 2023; 109:104965. [PMID: 36821873 DOI: 10.1016/j.archger.2023.104965] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Comprehensive medicines reviews are a strategy to reduce medicines-related harm. In Australia, Home Medicines Review services (HMRs) are provided by consultant pharmacists to community-dwelling consumers, on referral from the consumer's medical practitioner. Limited research exists on the processes undertaken by consultant pharmacists when delivering HMRs, particularly as it relates to the information types received, collected, and reported. OBJECTIVE Describe the types of information consultant pharmacists report receiving in HMR referrals, collect before and during consumer consultations, and include in their written reports. MATERIALS AND METHODS We conducted a national online survey of Australian consultant pharmacists who deliver HMRs. Participants were recruited using a broad advertising strategy, including social and traditional media platforms, and snowballing. Data were analysed descriptively. RESULTS Of the 248 eligible participants, 179 (72%) completed the survey. The most commonly included information in the referral was medication list (97%), the least were details of hospitalisations (8%) and specialist letters (5%). Information pertaining to hospitalisation and specialist letters were collected by 20% of participants prior to the consultation. Details of, and history from, community pharmacy was the most sought information prior to consultations. Less than a quarter of participants 'most of the time' or 'always' formally assess adherence using a validated instrument during the consultation. Participants commonly (80%) report consumer concerns in the written report. CONCLUSIONS Consultant pharmacists collect a broad variety of information, beyond medicines-related content. Written HMR reports by consultant pharmacists were often reported to be consumer-centric.
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Affiliation(s)
- Kenneth Lee
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.
| | - Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Sydney, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
| | - Deborah Hawthorne
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia; Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Amy Theresa Page
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia; Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
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Patounas M, Lau ETL, Rigby D, Chan V, Nissen LM. Development and trial of an instrument to evaluate accredited pharmacists' clinical home medicines review reports in Australia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marea Patounas
- Faculty of Health, School of Clinical Sciences Queensland University of Technology Brisbane Australia
| | - Esther T. L. Lau
- Faculty of Health, School of Clinical Sciences Queensland University of Technology Brisbane Australia
| | - Deborah Rigby
- Faculty of Health, School of Clinical Sciences Queensland University of Technology Brisbane Australia
| | - Vincent Chan
- School of Health and Biomedical Sciences RMIT University Melbourne Australia
| | - Lisa M. Nissen
- Faculty of Health, School of Clinical Sciences Queensland University of Technology Brisbane Australia
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Sluggett JK, Collier LR, Bartholomaeus JD, Inacio MC, Wesselingh SL, Caughey GE. National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189898. [PMID: 34574821 PMCID: PMC8467825 DOI: 10.3390/ijerph18189898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/04/2022]
Abstract
Comprehensive medicines reviews such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) can resolve medicines-related problems. Changes to Australia’s longstanding HMR and RMMR programs were implemented between 2011 and 2014. This study examined trends in HMR and RMMR provision among older Australians during 2009–2019 and determined the impact of program changes on service provision. Monthly rates of general medical practitioner (GP) HMR claims per 1000 people aged ≥65 years and RMMR claims per 1000 older residents of aged care facilities were determined using publicly available data. Interrupted time series analysis was conducted to examine changes coinciding with dates of program changes. In January 2009, monthly HMR and RMMR rates were 0.80/1000 older people and 20.17/1000 older residents, respectively. Small monthly increases occurred thereafter, with 1.89 HMRs/1000 and 34.73 RMMRs/1000 provided in February 2014. In March 2014, immediate decreases of –0.32 (95%CI –0.52 to –0.11) HMRs/1000 and –12.80 (95%CI –15.22 to –10.37) RMMRs/1000 were observed. There were 1.07 HMRs/1000 and 35.36 RMMRs/1000 provided in December 2019. In conclusion, HMR and RMMR program changes in March 2014 restricted access to subsidized medicines reviews and were associated with marked decreases in service provision. The low levels of HMR and RMMR provision observed do not represent a proactive approach to medicines safety and effectiveness among older Australians.
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Affiliation(s)
- Janet K. Sluggett
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (M.C.I.); (G.E.C.)
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (L.R.C.); (J.D.B.); (S.L.W.)
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
- Correspondence:
| | - Luke R. Collier
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (L.R.C.); (J.D.B.); (S.L.W.)
| | - Jonathan D. Bartholomaeus
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (L.R.C.); (J.D.B.); (S.L.W.)
- School of Psychology, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Maria C. Inacio
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (M.C.I.); (G.E.C.)
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (L.R.C.); (J.D.B.); (S.L.W.)
| | - Steve L. Wesselingh
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (L.R.C.); (J.D.B.); (S.L.W.)
| | - Gillian E. Caughey
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (M.C.I.); (G.E.C.)
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (L.R.C.); (J.D.B.); (S.L.W.)
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6
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Patounas M, Lau ET, Chan V, Rigby D, Kyle GJ, Khatri J, Poudel A, Nissen LM. Home medicines reviews: a national survey of Australian accredited pharmacists' health service time investment. Pharm Pract (Granada) 2021; 19:2376. [PMID: 34457093 PMCID: PMC8370188 DOI: 10.18549/pharmpract.2021.3.2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists' experiences of HMR time investment. Objective This study aimed to explore accredited pharmacists' experiences of HMR practice regarding time investment in the study's defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient's General Practitioner, including any liaison time). Methods An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment. Results There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing). Conclusions Accredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.
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Affiliation(s)
- Marea Patounas
- PhD, BPharm, MPS, AACPA, SFHEA. Lecturer, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT). Brisbane (Australia).
| | - Esther T Lau
- PhD, BPharm, MPS, GCResComm, GradCertAcadPrac, SFHEA. Senior Lecturer. Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT). Brisbane (Australia).
| | - Vincent Chan
- PhD, BPharm, MPH, MPS. Senior Lecturer. School of Health and Biomedical Sciences, RMIT University. Melbourne (Australia).
| | - Deborah Rigby
- BPharm, GradDipClinPharm, AdvPracPharm, FPS, FSHP, FACP, FASCP, FAICD. Clinical Associate Professor. Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT). Brisbane (Australia).
| | - Gregory J Kyle
- PhD, BPharm, MClinPharm, MPS. Faculty of Health, School of Clinical Sciences , Queensland University of Technology (QUT). Brisbane (Australia).
| | - Jyoti Khatri
- MPH, BPharm. Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT). Brisbane (Australia).
| | - Arjun Poudel
- PhD, BPharm, MSPharm. Faculty of Health, School of Clinical Sciences , Queensland University of Technology (QUT). Brisbane (Australia).
| | - Lisa M Nissen
- PhD, BPharm, AdvPracPharm, FPS, FHKAPh, FSHP. Professor and Head of School, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT). Brisbane (Australia).
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Home Medicines Review and frailty among community-dwelling older women. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:548-555. [PMID: 34463322 DOI: 10.1093/ijpp/riab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs. METHODS The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women's Health from 2003 (aged 77-82 years) to 2017 (aged 91-96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time. KEY FINDINGS The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR. CONCLUSIONS Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Julie Byles
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, Callaghan, NSW, Australia.,Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Nicholas Egan
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Therese Kairuz
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
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8
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Residential Medication Management Reviews and continuous polypharmacy among older Australian women. Int J Clin Pharm 2021; 43:1619-1629. [PMID: 34091857 DOI: 10.1007/s11096-021-01294-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79-84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professionals.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Hikaka J, Hughes C, Jones R, Amende H, Connolly MJ, Martini N. Feasibility of a pharmacist-facilitated medicines review intervention for community-dwelling Māori older adults. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100018. [PMID: 35481129 PMCID: PMC9031728 DOI: 10.1016/j.rcsop.2021.100018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Objective Methods Results Conclusion A medicines review model developed with and for older Māori was feasible to deliver. Medicines reviews led to medicine and non-medicine related recommendations. Almost 10 recommendations were made per participant with high prescriber acceptance.
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Affiliation(s)
- Joanna Hikaka
- School of Pharmacy, University of Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
- Corresponding author at: School of Pharmacy, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | | | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, New Zealand
| | - Hunter Amende
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J. Connolly
- Waitematā District Health Board, Auckland, New Zealand
- Department of Geriatric Medicine, University of Auckland, New Zealand
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Factors associated with the intensity of government remunerated and unremunerated service provision in community pharmacies. Res Social Adm Pharm 2020; 17:1614-1622. [PMID: 33423903 DOI: 10.1016/j.sapharm.2020.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/25/2020] [Accepted: 12/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many community pharmacies provide medication and disease state management services with and without specific remuneration. Availability of these services is often reported, however little is known about factors influencing the intensity of their provision. OBJECTIVE To investigate factors associated with the intensity of provision of selected government remunerated and unremunerated community pharmacy services in Western Australia (WA). METHODS A questionnaire was mailed to a random sample of 421/628 (67%) community pharmacies in WA. The first dependent variable was intensity of government remunerated MedsCheck and Diabetes MedsCheck service frequencies per month. The second was the intensity of the sum of government unremunerated asthma screening, blood glucose testing, cholesterol testing and smoking cessation disease state management service frequencies per week. Principal Component Analysis defined attitudinal components influencing service provision. Linear regression with bootstrap confidence intervals determined variables associated with intensity of provision of the selected services. The variables were: pharmacist; pharmacy setting characteristics; and, attitudinal factors. RESULTS The questionnaire yielded a response rate of 49.2%. Attitudinal components that facilitated service provision were: general practitioners (GPs) willingness to collaborate; pharmacists are capable and ready; and pharmacists require further training. Staff capability and low return on investment were barriers to increased service provision. The intensity of government remunerated services was independently associated with pharmacies having pharmacy interns, fewer dispensary technicians, and being capable and ready to provide the services. Higher intensity of the provision of the unremunerated disease state management services was independently associated with the intensity of provision of MedsCheck and Diabetes MedsCheck services. CONCLUSIONS Improved pharmacy workflow, achieved by the availability of pharmacy interns, and pharmacists being capable and ready, were important factors in the intensity of MedsCheck and Diabetes MedsCheck services. Intensity of the provision of government remunerated services facilitated a higher prevalence of disease state management services provision.
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Sluggett JK, Bell JS, Lang C, Corlis M, Whitehead C, Wesselingh SL, Inacio MC. Variation in Provision of Collaborative Medication Reviews on Entry to Long-Term Care Facilities. J Am Med Dir Assoc 2020; 22:148-155.e1. [PMID: 33288466 DOI: 10.1016/j.jamda.2020.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Residential medication management reviews (RMMRs) are comprehensive medication reviews conducted by clinical pharmacists and general medical practitioners. RMMRs are the primary government-funded service to optimize medication management in Australian residential aged care facilities (RACFs) and are recommended for all new residents. This study investigated resident characteristics associated with timely RMMR provision within 90 days of RACF entry and national intrafacility variation in timely RMMR provision. DESIGN National retrospective cohort study. SETTING AND PARTICIPANTS Individuals aged ≥65 years who first entered permanent residential aged care in Australia between January 1, 2012, and December 31, 2015, received at least 1 medication in the previous year, and were alive at 90 days post-RACF entry. METHODS Resident characteristics associated with timely RMMR provision were determined using multivariate logistic regression. Crude and risk-adjusted funnel plots were used to examine intrafacility variation in timely RMMR provision. RESULTS Of the 143,676 residents from 2799 RACFs included, 30,883 (21.5%) received an RMMR within 90 days. Resident characteristics associated with timely provision included dementia (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.02-1.08), primary language other than English (aOR 1.04, 95% CI 1.01-1.09), number of unique prescriptions dispensed in the previous year (aOR [per additional 5 prescriptions] 1.02, 95% CI 1.01-1.03), need for medication administration assistance (aORs ranged from 1.35 to 1.42, compared with residents self-managing) and facility remoteness (aORs ranged from 0.67 to 0.75 for residents outside major cities). The proportion of new residents receiving a timely RMMR ranged from 0% (n = 303 RACFs) to 100% (n = 4 RACFs). There were 174 RACFs (6.2%) in which ≥50% of new residents received a timely RMMR. CONCLUSIONS AND IMPLICATIONS Although there was some evidence that RMMRs are targeted to individuals with a greater burden of medication use and those living with dementia, considerable variation in provision exists nationally. This flagship medication review service is generally underutilized among residents of Australian RACFs.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Megan Corlis
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Department of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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