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Alharthi M, Wright D, Scott S, Birt L. Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers. Res Social Adm Pharm 2023; 19:746-752. [PMID: 36732210 DOI: 10.1016/j.sapharm.2023.01.013] [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: 11/10/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Over 70% of care home residents are prescribed potentially inappropriate medications (PIMs) associated with morbidity and mortality. Deprescribing is a common recommendation by pharmacists performing medication reviews in care homes, however requiring prescriber authorisation is a barrier. Care home Independent Pharmacist Prescribing Study (CHIPPS), a cluster randomised control trial integrated pharmacist independent prescriber (PIPs) into care homes to improve medication management, providing a unique opportunity to identify their barriers and enablers to deprescribing. OBJECTIVES To identify barriers and enablers to PIPs deprescribing medications in care homes. METHODS Secondary qualitative framework analysis was performed on interviews with CHIPPS' PIPs. A maximum variation sampling approach was used to select from the 14 PIPs included in the process evaluation to achieve diversity of PIPs' contextual factors e.g., previous experience in care homes. Transcripts were coded inductively for barriers and enablers to deprescribing and then mapped to Theoretical Domains Framework (TDF). RESULTS Eleven PIP's interviews were sampled. Factors acted as enablers and barriers were PIP relationship with General Practitioner (GP), care home staff and residents/families, awareness of the PIP role and family trust in PIPs' deprescribing activities (social influences); PIPs' independent prescribing confidence, previous experience and ability dealing with residents' medications (beliefs about capabilities); understanding of PIP role and PIP confidence in their role as an independent prescriber (Social/professional role and identity); access to residents' records, deprescribing decision support, regular follow-up from care home staff, resident difficulties with medications, teamwork, and time restraints (Environmental context and resources). One factor acted as a barrier: believing negatives of deprescribing outweigh benefits regarding certain medications (Beliefs about consequences). CONCLUSION PIPs' involvement in deprescribing within care homes is influenced by multiple barriers and enablers. Data mapped to TDF domains represent barriers that need addressing and enablers that should be highlighted to enhance PIPs' effectiveness in future interventions.
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Affiliation(s)
- Mohammed Alharthi
- School of Healthcare, University of Leicester, Leicester, UK; College of Pharmacy, Taif University, Taif, Saudi Arabia.
| | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
| | - Sion Scott
- School of Healthcare, University of Leicester, Leicester, UK
| | - Linda Birt
- School of Healthcare, University of Leicester, Leicester, UK
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Alharthi M, Scott S, Alldred DP, Holland R, Hughes C, Birt L, Blacklock J, Bond C, Clark A, Wright D. Pharmacist-independent prescriber deprescribing in UK care homes: Contextual factors associated with increased activity. Br J Clin Pharmacol 2023; 89:1509-1513. [PMID: 36516106 DOI: 10.1111/bcp.15643] [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: 01/08/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS The Care Home Independent Pharmacist Prescriber Study (CHIPPS) process evaluation hypothesized that contextual factors influenced the likelihood of deprescribing by pharmacist-independent prescribers. The aim of this paper is to test this hypothesis. METHODS From CHIPPS study data, medications deprescribed totalled 284 for 370 residents in UK care homes. Regression analysis was used to describe the relationship between the number of medicines stopped and contextual factors (number of residents cared for, pharmacist employment within associated medical practice, previous care home experience, hours active within trial, years' experience as a pharmacist and as a prescriber). RESULTS Number of residents and pharmacist-independent prescriber employment within a medical practice were positive predictors of deprescribing. CONCLUSION Previous experiences were not related to deprescribing likelihood. Increasing the number of residents increases the opportunity for deprescribing and therefore this relationship is intuitive. The location within a medical practice is an interesting finding that requires further exploration to understand its exact nature.
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Affiliation(s)
- Mohammed Alharthi
- School of Healthcare, University of Leicester, Leicester, UK.,College of Pharmacy, Taif University, Taif, KSA
| | - Sion Scott
- School of Healthcare, University of Leicester, Leicester, UK
| | - David Phillip Alldred
- School of Healthcare, University of Leeds; NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Leeds, UK
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Linda Birt
- School of Healthcare, University of Leicester, Leicester, UK
| | | | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Allan Clark
- School of Medicine, University of Easy Anglia, Norwich, UK
| | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
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Holland R, Bond C, Alldred DP, Arthur A, Barton G, Birt L, Blacklock J, Blyth A, Cheilari S, Daffu-O'Reilly A, Dalgarno L, Desborough J, Ford J, Grant K, Harry B, Hill H, Hughes C, Inch J, Maskrey V, Myint P, Norris N, Poland F, Shepstone L, Spargo M, Turner D, Watts L, Zermansky A, Wright D. Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial. BMJ 2023; 380:e071883. [PMID: 36787910 PMCID: PMC9926330 DOI: 10.1136/bmj-2022-071883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes. DESIGN Cluster randomised controlled trial, with clusters based on triads of a pharmacist independent prescriber, a general practice, and one to three associated care homes. SETTING Care homes across England, Scotland, and Northern Ireland, their associated general practices, and pharmacy independent prescribers, formed into triads. PARTICIPANTS 49 triads and 882 residents were randomised. Participants were care home residents, aged ≥65 years, taking at least one prescribed drug, recruited to 20 residents/triad. INTERVENTION Each pharmacy independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits over six months. Pharmacy independent prescribers developed a pharmaceutical care plan for each resident, did medicines reviews/reconciliation, trained staff, and supported with medicines related procedures, deprescribing, and authorisation of prescriptions. Participants in the control group received usual care. MAIN OUTCOMES MEASURES The primary outcome was fall rate/person at six months analysed by intention to treat, adjusted for prognostic variables. Secondary outcomes included quality of life (EQ-5D by proxy), Barthel score, Drug Burden Index, hospital admissions, and mortality. Assuming a 21% reduction in falls, 880 residents were needed, allowing for 20% attrition. RESULTS The average age of participants at study entry was 85 years; 70% were female. 697 falls (1.55 per resident) were recorded in the intervention group and 538 falls (1.26 per resident) in the control group at six months. The fall rate risk ratio for the intervention group compared with the control group was not significant (0.91, 95% confidence interval 0.66 to 1.26) after adjustment for all model covariates. Secondary outcomes were not significantly different between groups, with exception of the Drug Burden Index, which significantly favoured the intervention. A third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. No adverse events or safety concerns were identified. CONCLUSIONS Change in the primary outcome of falls was not significant. Limiting follow-up to six months combined with a small proportion of interventions predicted to affect falls may explain this. A significant reduction in the Drug Burden Index was realised and would be predicted to yield future clinical benefits for patients. This large trial of an intensive weekly pharmacist intervention with care home residents was also found to be safe and well received. TRIAL REGISTRATION ISRCTN 17847169.
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Affiliation(s)
- Richard Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Linda Birt
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Annie Blyth
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Lindsay Dalgarno
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Joanna Ford
- Geriatric Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Bronwen Harry
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Helen Hill
- Stow Healthcare Ltd, Bury St. Edmunds, UK
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Jacqueline Inch
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Phyo Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nigel Norris
- School of Education and Lifelong Learning, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Maureen Spargo
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
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Prevalence of Potentially Inappropriate Prescriptions According to the New STOPP/START Criteria in Nursing Homes: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11030422. [PMID: 36766997 PMCID: PMC9914658 DOI: 10.3390/healthcare11030422] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population.
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Birt L, Wright DJ, Blacklock J, Bond CM, Hughes CM, Alldred DP, Holland R, Scott S. Enhancing deprescribing: A qualitative understanding of the complexities of pharmacist-led deprescribing in care homes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6521-e6531. [PMID: 36336895 PMCID: PMC10100492 DOI: 10.1111/hsc.14099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/15/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
The English National Overprescribing Review identified that older people often take eight or more medicines a day. The report recommended pharmacists in primary care should take responsibility for addressing polypharmacy. Overprescribing is a safety concern in care homes as approximately half of older care home residents are prescribed at least one medicine that is unnecessary or now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing is the planned activity of stopping or reducing a medicine that may no longer be appropriate. Deprescribing, when performed by a pharmacist, is a multidisciplinary activity requiring close communication with general practitioners (GPs) and care home staff. A recently completed trial that integrated pharmacists with prescribing rights into older peoples' care homes found significant variation in proactive deprescribing activity. The aim of the current study was to specifically explore beliefs and practices of deprescribing in care homes. A qualitative approach was adopted to examine individual, social and contextual factors that acted as enablers and barriers to pharmacist deprescribing in care homes. Semi-structured interviews were conducted with participants of the previous study (16 pharmacists, 6 GPs and 7 care home staff from Northern Ireland, Scotland and England). Using thematic analysis, we identified two themes: (a) Structures and systems affecting deprescribing, that is the context in which deprescribing happened, including team involvement and routine practices in GP surgeries and care homes; (b) Balancing risks when deprescribing, that is the perception of individual risk and social barriers were mitigated by understanding the medical background of residents. This supported the clinical understanding that risks from overprescribing were greater than risks from deprescribing. While deprescribing can involve all health professionals in the primary care team, these results suggest the pharmacist is well placed to lead the process; by having both clinical competence and professional willingness to drive this activity forward.
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Affiliation(s)
- Linda Birt
- School Allied Health ProfessionalsUniversity of LeicesterLeicesterUK
| | - David J. Wright
- Allied Health ProfessionalsUniversity of LeicesterLeicesterUK
| | | | - Christine M. Bond
- Institute of Applied Health SciencesUniversity of AberdeenLeicesterUK
| | | | | | | | - Sion Scott
- Allied Health ProfessionalsUniversity of LeicesterLeicesterUK
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6
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Birt L, Dalgarno L, Bond CM, Holland R, Alldred DP, Hughes C, Blyth A, Watts L, Wright DJ. Evaluation of a training programme for Pharmacist Independent Prescribers in a care home medicine management intervention. BMC MEDICAL EDUCATION 2022; 22:551. [PMID: 35840960 PMCID: PMC9287970 DOI: 10.1186/s12909-022-03575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The provision of independent prescribing rights for United Kingdom (UK) pharmacists has enabled them to prescribe within their area of competence. The aim of this study was to evaluate an evidence-based training programme designed to prepare Pharmacist Independent Prescribers (PIPs) to safely and effectively assume responsibility for pharmaceutical care of older people in care homes in the UK, within a randomised controlled trial. METHODS The training and competency assessment process included two training days, professional development planning against a bespoke competency framework, mentor support, and a viva with an independent General Practitioner (GP). Data on the PIPs' perceptions of the training were collected through evaluation forms immediately after the training days and through online questionnaires and interviews after delivery of the 6-month intervention. Using a mixed method approach each data set was analysed separately then triangulated providing a detailed evaluation of the process. Kaufman's Model of Learning Evaluation guided interpretations. RESULTS All 25 PIPs who received the training completed an evaluation form (N = 25). Post-intervention questionnaires were completed by 16 PIPs and 14 PIPs took part in interviews. PIPs reported the training days and mentorship enabled them to develop a personalised portfolio of competence in preparation for discussion during a viva with an independent GP. Contact with the mentor reduced as PIPs gained confidence in their role. PIPs applied their new learning throughout the delivery of the intervention leading to perceived improvements in residents' quality of life and medicines management. A few PIPs reported that developing a portfolio of competence was time intensive, and that further training on leadership skills would have been beneficial. CONCLUSIONS The bespoke training programme was fit for purpose. Mentorship and competency assessment were resource intensive but appropriate. An additional benefit was that many PIPs reported professional growth beyond the requirement of the study. TRIAL REGISTRATION The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17,847,169 ).
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Affiliation(s)
- L Birt
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- School of Allied Health Professions, University of Leicester, Leicester, UK.
| | - L Dalgarno
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - C M Bond
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - R Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - D P Alldred
- School of Healthcare, University of Leeds, Leeds, UK
| | - C Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - A Blyth
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - L Watts
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - D J Wright
- School of Allied Health Professions, University of Leicester, Leicester, UK
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
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7
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Caçador C, Teixeira-Lemos E, Oliveira J, Pinheiro J, Teixeira-Lemos L, Ramos F. The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052637. [PMID: 35270323 PMCID: PMC8910092 DOI: 10.3390/ijerph19052637] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a population of older adults living in nursing homes. Furthermore, we also intended to assess the possible association between polypharmacy, potentially inappropriate medications and cognitive impairment in institutionalized older adults. A cross-sectional study analyzed data from 193 nursing home residents in the district of Viseu, Portugal, between September 2018 and June 2019, with a mean age of 82.4 ± 6.2 years (ranging from 65 to 95 years old); 72.5% (n = 140) were female participants. Major polypharmacy was presented in 80.8% of the study population, who took 7.6 ± 3.3 drugs per day. Using the Beers Criteria, we found that 79.3% took PIMs. There was a positive association between polypharmacy and PIM (p < 0.001), showing that higher medicines intake increased the number of PIMs. Polypharmacy was not associated with the functionality of the older adults to perform activities of daily living, but was associated with cognitive impairment. The older adults with lower scores on the Mini Mental State Examination (MMSE) took more drugs (p = 0.039) and used more PIM (p < 0.001). Moreover, patients taking five or more prescription drugs per day (major polypharmacy) consuming any psychiatric, gastrointestinal or oral antidiabetic agents (regardless of whether they were considered potentially inappropriate or not) had higher odds of displaying cognitive impairment than those who did not (p < 0.05). Older adult residents of the studied nursing homes were potentially affected by polypharmacy and inappropriate polypharmacy. This observation reveals the need to adopt and implement strategies that make drug therapy more adequate and safer for older adults.
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Affiliation(s)
- Catarina Caçador
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
| | - Edite Teixeira-Lemos
- ESAV, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; (E.T.-L.); (J.O.)
- CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Jorge Oliveira
- ESAV, Polytechnic Institute of Viseu, 3500-606 Viseu, Portugal; (E.T.-L.); (J.O.)
- CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - João Pinheiro
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Luís Teixeira-Lemos
- Nuclear Medicine Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal;
| | - Fernando Ramos
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, R. D. Manuel II, Apartado, 55142 Oporto, Portugal
- Correspondence: or ; Tel.: +351-239-488492; Fax: +351-239-488503
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8
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Robinson A, Elarbi M, Todd A, Husband A. A qualitative exploration of the barriers and facilitators affecting ethnic minority patient groups when accessing medicine review services: Perspectives of healthcare professionals. Health Expect 2021; 25:628-638. [PMID: 34951087 PMCID: PMC8957739 DOI: 10.1111/hex.13410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Healthcare inequalities and ethnicity are closely related. Evidence has demonstrated that patients from ethnic minority groups are more likely to report a long‐term illness than their white counterparts; yet, in some cases, minority groups have reported poorer adherence to prescribed medicines and may be less likely to access medicine services. Knowledge of the barriers and facilitators that impact ethnic minority access to medicine services is required to ensure that services are fit for purpose to meet and support the needs of all. Methods Semistructured interviews with healthcare professionals were conducted between October and December 2020, using telephone and video call‐based software. Perspectives on barriers and facilitators were discussed. Interviews were audio‐recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Faculty of Medical Sciences Ethics Committee. Results Eighteen healthcare professionals were interviewed across primary, secondary and tertiary care settings; their roles spanned medicine, pharmacy and dentistry. Three themes were developed from the data regarding the perceived barriers and facilitators affecting access to medicine services for ethnic minority patients. These centred around patient expectations of health services; appreciating cultural stigma and acceptance of certain health conditions; and individually addressing communication and language needs. Conclusion This study provides much‐needed evidence relating to the barriers and facilitators impacting minority ethnic communities when seeking medicine support. The results of this study have important implications for the delivery of person‐centred care. Involving patients and practitioners in coproduction approaches could enable the design and delivery of culturally sensitive and accessible medicine services. Patient or Public Contribution The Patient and Public Involvement and Engagement (PPIE) group at Newcastle University had extensive input in the design and concept of this study before the research was undertaken. Throughout the work, a patient champion (Harpreet Guraya) had input in the project by ensuring that the study was conducted, and the findings were reported, with cultural sensitivity.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Muna Elarbi
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Haider I, Naunton M, Davey R, Peterson GM, Baqir W, Kosari S. How Do Pharmacists Practice in Aged Care? A Narrative Review of Models from Australia, England, and the United States of America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312773. [PMID: 34886501 PMCID: PMC8657381 DOI: 10.3390/ijerph182312773] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023]
Abstract
Medication management in residential aged care facilities (RACFs) is complex and often sub-optimal. Pharmacist practice models and services have emerged internationally to address medication-related issues in RACFs. This narrative review aimed to explore pharmacist practice models in aged care in Australia, England and the USA, and identify key activities and characteristics within each model. A search strategy using key terms was performed in peer-reviewed databases, as well as the grey literature. Additionally, experts from the selected countries were consulted to obtain further information about the practice models in their respective countries. Thirty-six documents met the inclusion criteria and were included in the review. Four major pharmacist practice models were identified and formed the focus of the review: (1) the NHS’s Medicine Optimisation in Care Homes (MOCH) program from England; (2) the Australian model utilising visiting accredited pharmacists; (3) the Centers for Medicare and Medicaid (CMS) pharmacy services in long-term care from the USA; and (4) the Medication Therapy Management (MTM) program from the USA. Medication reviews were key activities in all models, but each had distinct characteristics in relation to the comprehensiveness, who is eligible, and how frequently residents receive medication review activity. There was heterogeneity in the types of facility-level activities offered by pharmacists, and further research is needed to determine the effectiveness of these activities in improving quality use of medicines in the aged care setting. This review found that in some models, pharmacists have a limited level of collaboration with other healthcare professionals, emphasising the need to trial innovative models with integrated services and increased collaboration to achieve a holistic patient-centred approach to medication management.
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Affiliation(s)
- Ibrahim Haider
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (M.N.); (G.M.P.); (S.K.)
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia;
- Correspondence:
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (M.N.); (G.M.P.); (S.K.)
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia;
| | - Gregory M. Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (M.N.); (G.M.P.); (S.K.)
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia
| | - Wasim Baqir
- NHS England and NHS Improvement, London SE1 6LH, UK;
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (M.N.); (G.M.P.); (S.K.)
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10
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Evaluation of a New Home Patient Services Practicum for Community Pharmacy Students in Japan. PHARMACY 2021; 9:pharmacy9030120. [PMID: 34209839 PMCID: PMC8293358 DOI: 10.3390/pharmacy9030120] [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: 05/25/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the usefulness of the practicum as well as assess the knowledge, skills, and various specific realizations that the students gained from it. A total of 244 students role-played a scenario in which a pharmacist visited a patient at home and provided pharmaceutical management services. After completing the practicum, the students completed (i) a questionnaire survey consisting of six questions that assessed their level of understanding of the role of pharmacists in home medical care and (ii) a rubric survey that evaluated their learning achievement. In addition, they submitted practicum portfolios describing the patients' living conditions, physical conditions, and background as well as the services that required consideration of said variables. Their responses to the portfolio item "What were noticed through the practicum" were analyzed using the grounded theory approach. After the practicum, 45% and 53% of the students reported having a full and partial understanding of a pharmacists' role in home medical care. The students' mean ± standard deviation rubric score was 3.0 ± 0.4. They classified monitoring drug use, support for improving medication adherence, and observation to identify side effects early as major service categories in home medical care. The practicum led the students to perceive the need for communication with patients and various healthcare professionals to improve their readiness for practical training.
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Wright DJ, Blyth A, Maskrey V, Norris N, Bond CM, Hughes CM, Alldred DP, Holland RC. Development and feasibility testing of an evidence-based training programme for pharmacist independent prescribers responsible for the medicines-related activities within care homes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:376-384. [PMID: 34018561 DOI: 10.1093/ijpp/riab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/20/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The UK pharmacists with independent prescribing rights (pharmacist independent prescribers [PIPs]) are authorised to prescribe within their areas of competence. To enable PIPs to provide pharmaceutical care to residents in care homes and assume responsibility for medicines management, a process for development and assessment of competence is required. The aim of this research was to develop a training and accreditation process (training programme) to enable PIPs to operate safely and effectively within care homes. METHODS Located in England, Scotland and Northern Ireland across four sites and based on a systematic review, it consisted of four phases: (1) initial stakeholder engagement, (2) uni-professional focus groups and interviews, (3) expert panel consensus and (4) feasibility testing. Four PIPs were trained each to provide pharmaceutical care to 10 care home residents. An expert panel synthesised the evidence at each stage to develop each iteration of the training programme. Content analysis was used throughout. RESULTS Differences in baseline knowledge of PIPs required inclusion of a Personal Development Framework and the provision of a mentor. Face-to-face training focussed on managing medicines for a complex older person, minimising prescribing costs and supporting people without capacity. Provision of time to understand local context and develop relationships with care homes and general practitioners was identified as a central requirement. PIPs were assessed for competency via viva. Feasibility testing demonstrated that the derived training programme was acceptable, practical and effective. DISCUSSION The model seemed to work, but due to small numbers, larger-scale testing of the training programme is now required.
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Affiliation(s)
- David J Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Annie Blyth
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Vivienne Maskrey
- School of Medicine, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Nigel Norris
- School of Education, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Christine M Bond
- General Practice & Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - David P Alldred
- School of Healthcare, University of Leeds, Leeds, UK
- Yorkshire and Humber NIHR Patient Safety Translational Research Centre/University of Leeds, Leeds, UK
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Fowler Davis S, Cholerton R, Freeman-Parry L, Tsoneva J. The Contribution of Pharmacists and Pharmacy Technicians to Person-Centred Care within a Medicine's Optimisation in Care Homes Service: A Qualitative Evaluation. PHARMACY 2021; 9:pharmacy9010034. [PMID: 33578673 PMCID: PMC7931069 DOI: 10.3390/pharmacy9010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
Pharmacists and pharmacy technicians seek to improve person-centred care. Improvements to systems for care homes seeks to reduce medicines waste and inefficiency, particularly through supporting care home staff, to enhance safer administration of medicines. A complex evaluation used qualitative design and utilised narrative enquiry, and team members and key stakeholders were interviewed. Framework analysis was used, aligning findings to a person-centred care framework for older people. The Medicines Optimisation in Care Homes (MOCH) team brokered improvement practices across care homes to enhance person-centred care. The framework analysis confirms that the team used ‘authentic attention’ in relation to the residents’ experiences and flexibility in relation to negotiating medication. The importance of transparency of processes and systems in medicines management is highlighted, alongside requirements for person-centred care to make explicit the reason for taking a medication, and the continuous discussion with a range of stakeholders about the continuing need for particular medications. The outcome of the evaluation includes insights into a new area of pharmacy practice in community, based on the skills, knowledge, and experience of pharmacists and pharmacy technicians working in the care home sector. Further study is needed into the efficacy and outcomes of medicines management interventions.
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Affiliation(s)
- Sally Fowler Davis
- College of Health Wellbeing and Life Sciences, Sheffield Business School, Sheffield Hallam University, Sheffield S1 1WB, UK; (R.C.); (L.F.-P.)
- Correspondence:
| | - Rachel Cholerton
- College of Health Wellbeing and Life Sciences, Sheffield Business School, Sheffield Hallam University, Sheffield S1 1WB, UK; (R.C.); (L.F.-P.)
| | - Louise Freeman-Parry
- College of Health Wellbeing and Life Sciences, Sheffield Business School, Sheffield Hallam University, Sheffield S1 1WB, UK; (R.C.); (L.F.-P.)
| | - Jo Tsoneva
- Sheffield NHS Clinical Commissioning Group, Sheffield S9 4EU, UK;
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Osorio-de-Castro CGS, Ferreira TDJN, Silva MJSD, Miranda ES, Teodoro CRDS, Moraes EL, Lima EDC, Santos-Pinto CDB. An ontology of Pharmaceutical Services in the pages of Journal Ciência & Saúde Coletiva. CIENCIA & SAUDE COLETIVA 2020; 25:4887-4916. [PMID: 33295509 DOI: 10.1590/1413-812320202512.19112020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
Pharmaceutical Services (PS) is a growing field which has established itself over the last 25 years in Brazil through scientific publications. This work investigates the evolution of the field in the Brazilian periodical Journal Ciência & Saúde Coletiva. We conducted a scoping review of relevant literature produced in four separate periods (1996-2003, 2004-2010, 2011-2015, and 2016-2019). A search for articles that contained one or more of the pre-established key words in the title was performed by separate pairs of reviewers. The search resulted in 307 articles, 260 of which were included. The findings show that the number of publications increased steadily over the study period. The papers were predominantly open-topic and original articles and written in Portuguese. Most of the lead authors were from the South and Southeastern regions of Brazil and from public universities and Fiocruz. The predominant primary theme was medicine utilization (161 articles), followed by management (56), and tangential aspects of the PM cycle (43). An ontology of PS was created based on the classification of the articles. The findings show that the field of PS encompasses public policy and management and frontline activities involved in the delivery of health care to the population. It is hoped that the diverse range of interrelations in the field of PS will be increasingly addressed in future publications.
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Affiliation(s)
- Claudia Garcia Serpa Osorio-de-Castro
- Departamento de Política de Medicamentos e Assistência Farmacêutica, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Tatiana de Jesus Nascimento Ferreira
- Departamento de Política de Medicamentos e Assistência Farmacêutica, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | - Elaine Silva Miranda
- Departamento de Farmácia e Administração Farmacêutica, Faculdade de Farmácia, Universidade Federal Fluminense. Niterói RJ Brasil
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