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Cox LS, Naunton M, Peterson GM, Bagheri N, Bennetts JP, Koerner J, Davey R, Kosari S. The rate, causes and predictors of ambulance call outs to residential aged care in the Australian Capital Territory: A retrospective observational cohort study. PLoS One 2024; 19:e0311019. [PMID: 39348345 PMCID: PMC11441681 DOI: 10.1371/journal.pone.0311019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 09/09/2024] [Indexed: 10/02/2024] Open
Abstract
Older people in residential aged care are susceptible to acute illness or injury which may necessitate an ambulance call out, assessment/treatment by a paramedic and transfer to a hospital emergency department. Understanding the case mix of residential aged care ambulance attendances is important for prevention strategies and for planning services. A retrospective observational closed cohort study was designed to investigate the characteristics of emergency ambulance call outs to 15 residential aged care sites in the Australian Capital Territory over a 12-month period. Data were collected from the local ambulance service and the aged care sites. Case load data were analysed to determine rates, clinical characteristics, ambulance attendance outcomes and the temporal distribution of call outs. A Poisson regression model was developed to investigate demographic, morbidity and medication-related risk factors associated with the number of ambulance call outs per resident. Annual ambulance call out costs were estimated. There were 1,275 residents, with 396 (31.1%) requiring at least one ambulance call out over 12 months. Of 669 ambulance attendances, the majority (87.0%) were transported to emergency departments. Trauma (23.9%), pain (16.9%) and infections (9.4%) were the most common primary assessments by the ambulance attendees. Cases/day were similar throughout the year and on weekdays compared to weekends/public holidays. The main predictors of ambulance call out were multi-morbidity, taking regular anticholinergic medicines, being male and younger age. Estimated costs of ambulance call outs/year were $475/resident and $40,375/residential aged care site. The most frequent primary assessments (trauma, pain, infections) may constitute priorities for developing prevention strategies and for treatment initiatives within residential aged care. Strategies to reduce anticholinergic medication prescribing may also be a potential intervention to decrease ambulance call outs and hospital emergency department demand. The ambulance usage data from this study may be useful to compare with future datasets to measure the impact of the introduction of new services.
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Affiliation(s)
- Louise S. Cox
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Gregory M. Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Nasser Bagheri
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Jake Paul Bennetts
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Jane Koerner
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
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Davy C, Windle A, Marshall A, Harvey G. Leading the way: implementing aged care innovations. JBI Evid Implement 2024:02205615-990000000-00132. [PMID: 39291725 DOI: 10.1097/xeb.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVES The objective of this study was to identify the key characteristics of leaders that support the implementation of innovations in aged care settings. METHODS We conducted a secondary analysis of papers from a large scoping review that identified how leaders supported the implementation of innovations in aged care. Once imported into NVivo12, the findings were deductively coded using the domains of Bloom's taxonomy of learning. Each parent code was then inductively analyzed to identify key characteristics within each domain. RESULTS Our review identified four types of knowledge, five skills, and six attitudes that leaders should exhibit to better support the implementation of innovations within aged care settings. In addition to our findings regarding Bloom's learning domains, we identified nine leadership behaviors that participants in the included papers perceived as valuable for enhancing the implementation process. Furthermore, we identified four key organizational elements that support leaders in navigating and facilitating the implementation of innovations within aged care settings. CONCLUSION Our review identified the characteristics that leaders should demonstrate when supporting the implementation of innovations in aged care. Importantly, our findings also emphasized the changing role of leadership from a hierarchical approach to a more collaborative, supportive, and empowering style. The insights identified in this review will help to guide aged care leaders, stressing the significance of adaptable and relational leadership styles that will guide the implementation of innovations within the aged care sector. SPANISH ABSTRACT http://links.lww.com/IJEBH/A271.
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Affiliation(s)
- Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Laird C, Williams KA, Benson H. Osteoporosis management in Australian aged care facilities: a mixed method study. Arch Osteoporos 2024; 19:37. [PMID: 38744716 PMCID: PMC11093840 DOI: 10.1007/s11657-024-01401-7] [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: 02/19/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
Osteoporosis is a common but sub-optimally managed disease amongst aged care residents. Pharmacists undertaking comprehensive medication reviews is one strategy to improve osteoporosis management. Analysis of pharmacist medication review recommendations has identified common clinical practice issues that can be addressed to optimise osteoporosis management for aged care residents. PURPOSE This study investigates the prevalence of osteoporosis medicine use amongst Australian aged care residents and explores drug-related problems (DRPs) identified during medication reviews and pharmacist recommendations to resolve them. METHODS Resident demographics, medications, diagnoses, osteoporosis related DRPs, and recommendations to resolve them were extracted from medication review reports. A mixed methods approach was taken to analysis, involving descriptive statistical analysis and content analysis. RESULTS Medication review reports relating to 980 residents were collected. Antiresorptive therapies were used by 21.7% of residents, of which 87.2% were prescribed denosumab. Osteoporosis related DRPs represented 14.0% of all DRPs identified by pharmacists. Vitamin D was involved in 55.4% of these DRPs, the remainder concerned antiresorptive therapies (23.4%), medications contributing to osteoporosis (16.3%), and calcium (4.9%). Frequent deviations in practice from aged care clinical guidelines and consensus recommendations concerning vitamin D and calcium were found. DRPs and accompanying recommendations relating to denosumab revealed inadequate monitoring and inadvertent therapy disruptions. CONCLUSION Pharmacist identified DRPs and recommendations revealed common aspects of clinical practice that can be addressed to improve osteoporosis management for aged care residents. A need to raise awareness of aged care-specific consensus recommendations concerning vitamin D and calcium is evident. Facility protocols and procedures must be developed and implemented to ensure safe and effective use of denosumab.
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Affiliation(s)
- Catherine Laird
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| | - Helen Benson
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Hatem NAH, Ibrahim MIM, Yousuf SA. Exploring knowledge, attitudes and practice toward medication therapy management services among pharmacists in Yemen. PLoS One 2024; 19:e0301417. [PMID: 38578732 PMCID: PMC10997124 DOI: 10.1371/journal.pone.0301417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/16/2024] [Indexed: 04/07/2024] Open
Abstract
Medication therapy management (MTM) refers to the activities provided by pharmacists that patients recognize as evidence of care being provided. It encompasses the services that patients value and consider valuable. Many developing nations like Yemen have had poor implementation of MTM services. Thus, this research assessed the Knowledge, Attitudes, and Practices (KAP) of Yemen pharmacists regarding MTM. We conducted a cross-sectional study using a self-administered questionnaire among pharmacists in Sana'a, Yemen. They were recruited through convenience sampling. The alpha level of 0.05 was used to determine statistical significance. Four hundred and sixty-one (461) pharmacists completed the questionnaire. About 70% were working in community pharmacies and 57.3% had (1-5) years of experience in pharmacy practice. The younger pharmacists had a higher level of knowledge than pharmacists with older age with median and IQR of 1.2(1.2-1.4) and 1.2(1-1.4) respectively (p < 0.001). Yemen pharmacists have positive attitudes toward MTM indicating a moderated level of attitudes with a median and IQR of 3.8(3.5-4). Hospital pharmacists expressed more positive attitudes toward MTM (P < 0.001) than pharmacists from other areas of practice. Only 11% of sampled pharmacists frequently offered MTM services. The top MTM service reported by Yemen pharmacists was "Performing or obtaining necessary assessments of the patient's health status". However, "Formulating a medication treatment plan" received the least provided MTM service among Yemen pharmacists. Even though MTM services are not commonly utilized in pharmacy practice, Yemeni pharmacists have positive attitudes concerning MTM. Efforts are needed to enhance their MTM knowledge and the value of providing MTM services as well as to develop a culture of continuing pharmacy education about MTM among pharmacists.
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Affiliation(s)
- Najmaddin A. H. Hatem
- Department of Clinical Pharmacy, College of Clinical Pharmacy, Hodeidah University, Al-Hudaydah, Yemen
| | | | - Seena A. Yousuf
- Social Medicine and Public Health Department, Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen
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Cross AJ, Hawthorne D, Kouladjian O'Donnell L, Lee K, Page AT. Pharmacists working in residential aged care: a survey of pharmacist interest and perceived preparedness. Int J Clin Pharm 2024; 46:506-514. [PMID: 38315305 PMCID: PMC10960889 DOI: 10.1007/s11096-023-01686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pharmacists involvement in residential aged care facilities has traditionally been limited to that of an external contractor providing medication reviews, or medication supply. AIM To explore Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in residential aged care. METHOD National cross-sectional anonymous online survey open for two weeks (September 17th to October 1st 2022) consisting of Likert-type, multiple choice and multiple selection questions. Australian pharmacists were recruited using a broad advertising strategy which included social and traditional media platforms, and snowball sampling. Data were collected on pharmacist self-reported interest and perceived preparedness to work as on-site aged care pharmacists in residential aged care. Data were analysed using descriptive statistics. RESULTS Responses were received from 720 participants, 643 were eligible. Most participants were female (n = 466, 73%) and mean (SD) age was 43.5 (SD 12.5) years. Over half the participants were interested or extremely interested in working as an on-site aged care pharmacist (56%, n = 360), and agreed or strongly agreed (n = 475, 76%) that they felt prepared to work as an on-site aged care pharmacist. Most pharmacists felt prepared to engage in a variety of roles within the facilities (> 73% for each role), including resident and system level roles, and the majority agreed they felt prepared to engage with stakeholders, including general practitioners (93%) and medical specialists (86%). CONCLUSION Pharmacists reported they are interested and feel prepared to work as on-site aged care pharmacists. These findings will inform the roll-out of this new model of care to enhance multidisciplinary collaboration in residential aged care.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| | - Deborah Hawthorne
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Lisa Kouladjian O'Donnell
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
| | - Kenneth Lee
- Centre for Optimisation of Medicines, School of Allied Health, University of Western Australia, Crawley, Australia
| | - Amy Theresa Page
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
- Centre for Optimisation of Medicines, School of Allied Health, University of Western Australia, Crawley, Australia
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Cross AJ, Bell JS, Steeper M, La Caze A. Embedded on-site aged care pharmacists in Australia: Insights from early adopters of a new workforce model. Australas J Ageing 2024; 43:79-90. [PMID: 37877349 DOI: 10.1111/ajag.13254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To explore the roles of early adopters of Australia's embedded on-site pharmacist model in supporting quality use of medications in residential aged care facilities (RACFs). METHODS Qualitative semistructured interviews were conducted with 15 pharmacists working as embedded on-site pharmacists, or beyond the scope of traditional consultant pharmacist roles in Australian RACFs. Interviews were audio-recorded, transcribed and thematically analysed independently by two investigators using an inductive approach. Deductive analysis was also undertaken using a knowledge broker framework: knowledge manager, linkage agent and capacity builder. RESULTS Dominant themes were roles and benefits of embedded pharmacists, factors associated with success and challenges. Roles and benefits included (1) resident-level interventions and an enhanced ability to provide collaborative outcome-focussed resident-centred care, including timely input and follow-up, and improved relationships with residents, family and interdisciplinary team; and (2) system-level interventions such as contributing to clinical governance and quality improvement. Factors associated with success included personal capabilities and approach of the pharmacist, and organisational culture and sector-wide support. Challenges included pharmacist workforce shortages, perceived lack of pharmacist readiness and difficulty determining an appropriate service model. Deductive coding demonstrated roles of embedded pharmacists were consistent with all three activities of a knowledge broker. CONCLUSIONS This study highlights the resident- and system-level roles and benefits of embedded on-site pharmacists, and provides a framework for defining this emerging workforce model in Australian RACFs.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Victoria, Australia
| | - Michelle Steeper
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Victoria, Australia
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
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Rezae F, Kelly A, Dey S, Moles R, Carter S. Healthcare professionals' perspectives and experiences of osteoporosis medication treatment: a qualitative systematic review. Arch Osteoporos 2024; 19:8. [PMID: 38191760 DOI: 10.1007/s11657-023-01359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024]
Abstract
This systematic review aimed to explore healthcare professionals' (HCPs) experiences and perspectives of osteoporosis medication treatment through thematic synthesis of qualitative studies. We found themes about how osteoporosis is perceived as a disease, treatment decision-making and what empowers HCPs to provide the best possible care. PURPOSE The systematic review aimed to describe the perspectives and experiences of HCPs regarding osteoporosis medication treatment. METHODS We performed searches in four electronic databases (Medline, Embase, PsycINFO and CINAHL) from database inception until May 2023 in any language. Data was analysed through inductive thematic synthesis. RESULTS We included 27 primary studies that incorporated the views of 495 different HCPs. The following themes were identified: low-priority disease, challenges in treatment decision-making, minimising drug burden, conscious of communication barriers, fragmented care and advice, confidence through experience and collaboration. CONCLUSIONS HCPs were enthusiastic about optimising osteoporosis care through interprofessional collaboration and expertise, as well as educating and monitoring patients on treatment. They advocated for safety, comfort and reducing overall drug burden, especially in older patients with comorbidities. However, they had differences in opinions regarding who has responsibility for diagnosing and treating osteoporosis and struggled to provide the best possible care due to competing priorities, limited time and lack of adequate knowledge or evidence. The findings highlight the important and complementary role of different HCPs in osteoporosis treatment through a multidisciplinary model of care.
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Affiliation(s)
- Fatima Rezae
- School of Pharmacy, University of Sydney, Sydney, Australia.
| | - Ayano Kelly
- Rheumatology Department, Liverpool Hospital, Sydney, Australia
- Ingham Institute of Applied Medical Research, Sydney, Australia
- School of Health and Medicine, South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Sagarika Dey
- School of Clinical Medicine, South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Rebekah Moles
- School of Pharmacy, University of Sydney, Sydney, Australia
| | - Stephen Carter
- School of Pharmacy, University of Sydney, Sydney, Australia
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Cai R, Xi X, Huang Y. Association of the availability of pharmaceutical facilities provided in secondary and tertiary hospitals with clinical pharmacists' work performance. BMC Health Serv Res 2023; 23:1361. [PMID: 38057761 PMCID: PMC10698899 DOI: 10.1186/s12913-023-10390-1] [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: 01/11/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Clinical pharmacists always work as the pivotal role in the process of facilitating the proper use of drug. Based on the person-environment fit theory, the availability of facilities required in pharmaceutical service may influence pharmacists' performance, but which of them may have positive or negative impact remains unclear. OBJECTIVES This study aims to analysed the quantitative association of the availability of pharmaceutical facilities provided in Chinese hospitals and clinical pharmacists' work performance to assist hospitals formulating plans of the improving pharmaceutical working conditions to enhance clinical pharmacists' performance. METHOD Demonstrated by the panel of expert and literature review, the questionnaire for administrators and clinical pharmacists of secondary and tertiary hospitals in China was formed. Then a mixed sampling was adopted to gather data on information of the participants, as well as evaluation indexes of the availability of facilities and clinical pharmacists' work performance. RESULTS Overall, 625 questionnaires distributed to administrators of hospitals and 1219 ones distributed to clinical pharmacists were retrieved. As for the Pharmaceutical facilities, while the increased availability of Traditional Chinese medicine pharmacy (p = 0.02) has a significantly positive impact on clinical pharmacists' performance, the great availability of the preparation room (p = 0.07) negatively influences their work performance. CONCLUSION Improving the availability of facilities that significantly influence clinical pharmacists' work performance possibly reduce their workload, enhance their efficiency and further promote progress in pharmaceutical service.
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Affiliation(s)
- Rong Cai
- China Pharmaceutical University School of International Pharmaceutical Business, No. 639, Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, 211198, China
| | - Xiaoyu Xi
- China Pharmaceutical University School of International Pharmaceutical Business, No. 639, Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, 211198, China
| | - Yuankai Huang
- China Pharmaceutical University School of International Pharmaceutical Business, No. 639, Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, 211198, China.
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Haider I, Kosari S, Naunton M, Niyonsenga T, Koerner J, Peterson G, Davey R. Impact of on-site pharmacists in residential aged care facilities on the quality of medicines use: a cluster randomised controlled trial (PiRACF study). Sci Rep 2023; 13:15962. [PMID: 37749102 PMCID: PMC10519995 DOI: 10.1038/s41598-023-42894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
Residents of residential aged care facilities (RACFs) have a high prevalence of use of potentially inappropriate medications (PIMs) and resultant medicines-related harm. This study investigated the effect of an on-site pharmacist model on PIMs use and other medication outcomes for residents in RACFs. A multi-facility, non-blind, cluster randomised controlled trial, with randomisation at the facility level, was conducted. Fifteen facilities enrolled and participated in the study, 7 facilities (560 residents) were allocated to the intervention arm and 8 facilities (737 residents) were allocated to the control arm. Each facility in the intervention arm employed an on-site pharmacist for 12 months to perform medication management activities as part of an interdisciplinary care team. The primary outcome was the proportion of residents taking at least one PIM according to the 2019 Beers® Criteria. Using generalised linear mixed-effects models, accounting for confounders and clustering, there was a significant reduction in the proportion of residents prescribed at least one PIM (odds ratio 0.50, 95% confidence interval, 0.335-0.750; p = 0.001) in the intervention arm. There were also significant decreases in the Anticholinergic Cognitive Burden scale and chlorpromazine equivalent daily dose of antipsychotics. The on-site pharmacist intervention significantly improved the appropriateness of medicines use in RACFs.
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Affiliation(s)
- Ibrahim Haider
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Jane Koerner
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Gregory Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, 7005, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
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Laird C, Williams KA, Benson H. Perceptions and practices of aged care pharmacists regarding osteoporosis management: a qualitative study. Int J Clin Pharm 2023; 45:913-921. [PMID: 37162657 PMCID: PMC10366014 DOI: 10.1007/s11096-023-01586-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/25/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Osteoporosis is a common but sub-optimally managed disease among aged care residents. Although pharmacists are one of the key healthcare providers responsible for osteoporosis medication management there is limited research on their involvement. AIM This study explored the perceptions and practices of Australian pharmacists regarding osteoporosis management for aged care residents. METHOD Semi-structured interviews were conducted with aged care pharmacists. Interviews were recorded, transcribed, and analysed using a constructivist grounded theory approach. RESULTS Twenty-one aged care pharmacists were interviewed. Three main themes were identified: osteoporosis is highly prevalent but given low priority, factors affecting pharmacists' management of osteoporosis, and optimism for the future role of pharmacists in osteoporosis management. The complexity of aged care residents' healthcare needs and the silent, insidious nature of osteoporosis contribute to the low priority it is afforded. Barriers identified by pharmacists included their current practice model, limited access to residents' medical histories and difficulties accessing bone mineral density (BMD) testing. Interdisciplinary collaboration and education regarding osteoporosis management were seen as facilitators. Pharmacists were optimistic that an embedded practice model would improve their capacity to influence osteoporosis management. CONCLUSION The high prevalence and low priority of osteoporosis in the aged care setting presents pharmacists with an opportunity to improve medication management and reduce fracture risk. Barriers to osteoporosis management identified by pharmacists can be addressed by interdisciplinary collaboration and education. Pharmacists being embedded in aged care could enable more opportunities to contribute to the interdisciplinary team and become champions of osteoporosis management.
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Affiliation(s)
- Catherine Laird
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| | - Helen Benson
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Haider I, Kosari S, Naunton M, Koerner J, Dale M, Nizamani S, Davey R. The role of on-site pharmacist in residential aged care facilities: findings from the PiRACF study. J Pharm Policy Pract 2023; 16:82. [PMID: 37400921 DOI: 10.1186/s40545-023-00587-4] [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: 04/10/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Residents in residential aged care facilities (RACFs) have a high number of medication-related problems. Integrating on-site pharmacists (OSPs) into this setting is a possible solution and is currently gaining traction in Australia and internationally. The Pharmacists in Residential Aged Care Facilities (PiRACF) cluster-randomised controlled trial integrated pharmacists into the RACF care team to improve medication management. The aim of this descriptive observational study is to explore the activities of OSPs when they are integrated into multidisciplinary care team in RACFs. METHOD An online survey tool was developed to record the activities of OSPs in RACFs using the Qualtrics© software. OSPs were asked questions about their activities in RACFs under categories that included description, time spent, outcomes where applicable and who the pharmacists communicated with to undertake the activity. RESULTS Six pharmacists were integrated into 7 RACFs. Overall, they recorded 4252 activities over 12 months. OSPs conducted 1022 (24.0%) clinical medication reviews; 48.8% of medication reviews identified and discussed potentially inappropriate medications with prescribers and 1025 other recommendations were made to prescribers. Overall, the prescriber accepted 51.5% of all recommendations made by OSPs. The most frequently accepted outcome was deprescribing of medications (47.5% for potentially inappropriate medications and 55.5% for other recommendations). OSPs performed facility-level activities including staff education (13.4%), clinical audits (5.8%), and quality improvement activities (9.4%). OSPs spent a large proportion of their time communicating (23.4%) extensively with prescribers, RACF's healthcare team, and residents. CONCLUSION OSPs successfully performed a wide range of clinical activities aimed both at improving residents' medication regimens, and organisational-level quality improvement. The OSP model presents an opportunity for pharmacists to enhance medication management in the residential aged care setting. Trial registration The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN: ACTRN12620000430932) on April 1, 2020.
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Affiliation(s)
- Ibrahim Haider
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Jane Koerner
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Michael Dale
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Sundus Nizamani
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
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Cross AJ, Hawthorne D, Lee K, O'Donnell LK, Page AT. Factors influencing pharmacist interest and preparedness to work as on-site aged care pharmacists: Insights from qualitative analysis of free-text survey responses. Arch Gerontol Geriatr 2023; 110:104971. [PMID: 36842404 DOI: 10.1016/j.archger.2023.104971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND High rates of suboptimal medication use exist in residential aged care facilities (RACFs). Pharmacist interventions can improve medication appropriateness. In 2023 there will be a phased implementation of pharmacists working on-site in Australian RACFs. OBJECTIVE To explore factors influencing Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in RACFs. METHODS A national cross-sectional anonymous online survey of Australian pharmacists was conducted. Pharmacists were recruited using a broad advertising strategy. The 36-question survey included three free-text questions that are the focus of this study. The questions asked participants (1) what influenced their interest in the role, (2) what influenced how prepared they felt for the role, and (3) if they had any other comments about the role. Responses were thematically analysed by two investigators using an inductive approach. RESULTS Most survey respondents (n=546, 84.9%) answered at least one free-text questions. Four factors influenced interest: on-site pharmacist role, aged care setting, individual pharmacist circumstances and employment model. Four factors influenced preparedness: familiarity with aged care setting, resident-level clinical skills; ability to communicate and work with a multidisciplinary team, and experience with system-level quality use of medicines activities. Four factors important for successful roll-out emerged from the 'other comments': pharmacist attributes, pharmacist workforce planning, resources and support, and RACF stakeholder engagement. CONCLUSION Key factors influencing pharmacist interest and preparedness to work on-site in RACFs and factors important for success were identified. These findings will support the national roll-out of the role, particularly as most identified factors are currently modifiable.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, 381 Royal Parade, Parkville, Vic 3052, Australia.
| | - Deborah Hawthorne
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Kenneth Lee
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Ageing, Faculty of Medicine and Health, Kolling Institute, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Amy T Page
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia; Centre for Optimisation of Medicines, School of Allied Health, University of Western Australia, Crawley, Australia
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Ali S, Curtain CM, Peterson GM, Salahudeen MS. Exploring Australian pharmacists' perceptions and practices towards reducing the risk of medicines-related harm in aged care residents. Front Pharmacol 2023; 14:1131456. [PMID: 36937858 PMCID: PMC10014529 DOI: 10.3389/fphar.2023.1131456] [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: 12/25/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Background: Older people living in residential aged care facilities frequently experience medicines-related harm. Evidence regarding the perception and practices towards reducing these harms may facilitate the development of customised educational programs for pharmacists providing services in RACFs. Objective: To explore Australian pharmacists' opinions and practices towards reducing the risk of medicines-related harm in aged care residents. Methods: An online survey was developed based on a literature review, expert opinion, and feedback from pharmacists providing services in RACFs. A web link for the survey was shared via professional pharmacy organisations and social media groups with Australian pharmacists providing services in RACFs. Results: A total of 209 pharmacists participated in the survey. Of these, 76% (n = 158) were residential medication management review embedded pharmacists, and 24% (n = 51) were supply pharmacists for RACFs. Most pharmacists believed that medicines-related harm is common in residents (n = 174, 83%), yet few agreed that pharmacists have enough time to participate in medicines-related harm reduction services (n = 60, 28%). There was a high level of agreement regarding the key risk factors (e.g., inappropriate medicines, anticholinergic drug use, and transitions of care) and potential strategies (e.g., embedded pharmacists in RACFs, educating aged care staff, and collaborative pharmacist-led medication reviews) for reducing medicines-related harm in residents. Conclusion: Pharmacists agreed that older residents often experience medicines-related harm, but they did not frequently participate in medicines-related harm reduction services. Initiatives to engage pharmacists in team-based harm reduction services and educate aged care staff regarding safe medication management may improve residents' safety and health outcomes.
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Rendrayani F, Alfian SD, Wahyudin W, Puspitasari IM. Pharmacists' Knowledge, Attitude, and Practice of Medication Therapy Management: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10122513. [PMID: 36554036 PMCID: PMC9778396 DOI: 10.3390/healthcare10122513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Understanding pharmacists' knowledge, attitudes, and practices (KAP) and their perceptions of challenges, barriers, and facilitators towards medication therapy management (MTM) provision are vital in informing the design and implementation of successful service delivery. Thus, this review examined pharmacists' knowledge, attitudes, and practices, and their perceived challenges, barriers, and facilitators to MTM services provision, globally. A systematic search was conducted on 1-31 August 2022 to identify relevant studies on PubMed and EBSCO, supplemented with a bibliographic and a particular hand search. We focused on original research in quantitative survey form with the key concepts of "medication therapy management", "pharmacists", and "knowledge, attitude, practice". We assessed the reporting quality using the Checklist for Reporting of Survey Studies (CROSS). Results are reported narratively and according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. From 237 articles identified, 17 studies met the eligibility criteria. Of the included studies, five reported that pharmacists had a considerable level of knowledge, seven suggested a positive attitude among pharmacists, and five revealed that pharmacists had been practicing some MTM elements. Factors associated with pharmacists' KAP may include age, educational degree, additional qualification, income, years of practice, practice setting, and experience in patient care service. The challenges toward MTM provision were related to the pharmacist-patient and pharmacist-physician relationship. Insufficient time, staff, compensation, and training were the barriers, while patients' willingness to participate and educational background were the facilitators of MTM provision. These findings of studies on KAP could help develop an MTM program and design an intervention to improve program effectiveness. Further research focusing on other quantitative and qualitative studies of KAP is needed to obtain a comprehensive approach to MTM provision.
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Affiliation(s)
- Farida Rendrayani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, West Java, Indonesia
| | - Sofa Dewi Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, West Java, Indonesia
| | - Wawan Wahyudin
- Ciloto Health Training Centre, Ministry of Health Republic of Indonesia, Cianjur 43253, West Java, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, West Java, Indonesia
- Correspondence:
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Quality Use of Medicines Indicators and Associated Factors in Residential Aged Care Facilities: Baseline Findings from the Pharmacists in RACF Study in Australia. J Clin Med 2022; 11:jcm11175189. [PMID: 36079117 PMCID: PMC9457045 DOI: 10.3390/jcm11175189] [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: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Prescribing potentially inappropriate medications (PIMs), including antipsychotics and benzodiazepines, has been used as an indicator of the quality use of medicines in residential aged care facilities (RACFs). PIMs are associated with an increased risk of falls and hospitalisations in the elderly. The purpose of this study is to assess the extent of prescribing of PIMs in RACFs at baseline in the Pharmacists in residential aged care facilities (PiRACF) study and examine the association of resident and system factors with the number of PIMs. A cross-sectional analysis of 1368 participants from 15 Australian RACFs was performed to detect PIMs using the American Geriatrics Society 2019 Beers® criteria. Most residents (68.1%) were taking at least one regular PIM; 16.9% were taking regular antipsychotics and 11.1% were taking regular benzodiazepines. Long-term proton pump inhibitors were the most frequent class of PIMs. History of falls and higher Charlson Comorbidity Index were associated with an increased number of prescribed PIMs, while dementia diagnosis and older age (85 years or more) were associated with decreased number of PIMs (p-value <0.05). Residents in facilities with lower nurse-to-resident ratios were more likely to have an increased number of PIMs (p value = 0.001). This study indicates that potentially inappropriate prescribing is common in RACFs and interventions to target residents at highest risk are needed.
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