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Chambers D, Preston L, Clowes M, Cantrell AJ, Goyder EC. Pharmacist-led primary care interventions to promote medicines optimisation and reduce overprescribing: a systematic review of UK studies and initiatives. BMJ Open 2024; 14:e081934. [PMID: 39117409 DOI: 10.1136/bmjopen-2023-081934] [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] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES To systematically review and synthesise evidence on the effectiveness and implementation barriers/facilitators of pharmacist-led interventions to promote medicines optimisation and reduce overprescribing in UK primary care. DESIGN Systematic review. SETTING UK primary care. METHODS We searched MEDLINE, Embase, CINAHL PsycINFO and The Cochrane Library for UK-based studies published between January 2013 and February 2023. Targeted searches for grey literature were conducted in May 2023. Quantitative and qualitative studies (including conference abstracts and grey literature) that addressed a relevant intervention and reported a primary outcome related to changes in prescribing were eligible for inclusion. Quality of included studies was assessed using the Multiple Methods Appraisal Tool. We performed a narrative synthesis, grouping studies by publication status, setting and type of data reported (effectiveness or implementation). RESULTS We included 14 peer-reviewed journal articles and 11 conference abstracts, together with 4 case study reports. The journal articles reported 10 different interventions, 5 delivered in general practice, 4 in care homes and 1 in community pharmacy. The quality of evidence was higher in general practice than in care home settings. It was consistently reported that the intervention improved outcomes related to prescribing, although the limited number of studies and wide range of outcomes reported made it difficult to estimate the size of any effect. Implementation was strongly influenced by relationships between pharmacists and other health and care professionals, especially general practitioners. Implementation in care homes appeared to be more complex than in general practice because of differences in systems and 'culture' between health and social care. CONCLUSIONS Pharmacist-led interventions have been reported to reduce overprescribing in primary care settings in the UK but a shortage of high-quality evidence means that more rigorous studies using high-quality designs are needed. More research is also needed in community pharmacy settings; to assess intervention effects on patient outcomes other than prescribing and to investigate how reducing overprescribing can impact health inequalities. PROSPERO REGISTRATION NUMBER CRD42023396366.
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Affiliation(s)
- Duncan Chambers
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Louise Preston
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Mark Clowes
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Anna J Cantrell
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Elizabeth C Goyder
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, 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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Bezerra HS, Brasileiro Costa AL, Pinto RS, Ernesto de Resende P, Martins de Freitas GR. Economic impact of pharmaceutical services on polymedicated patients: A systematic review. Res Social Adm Pharm 2022; 18:3492-3500. [DOI: 10.1016/j.sapharm.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/27/2021] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
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Birt L, Dalgarno L, Wright DJ, Alharthi M, Inch J, Spargo M, Blacklock J, Poland F, Holland RC, Alldred DP, Hughes CM, Bond CM. Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS). BMC Health Serv Res 2021; 21:1041. [PMID: 34600542 PMCID: PMC8487235 DOI: 10.1186/s12913-021-07062-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation. Method Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework. Results PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention. Conclusions The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established. Trial registration The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07062-3.
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Affiliation(s)
- Linda Birt
- The Queen's Building, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Lindsay Dalgarno
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David J Wright
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | - Jackie Inch
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Maureen Spargo
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | - Fiona Poland
- The Queen's Building, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | | | - David P Alldred
- School of Healthcare, University of Leeds, Leeds, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Leeds, UK
| | | | - Christine M Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Thayer N, White S, Islam J, Jones W, Kenzie S, Kullu R. Reducing risks associated with medicines and lifestyle in a residential care population with intellectual disabilities: evaluation of a pharmacy review initiative in England. BMJ Open 2021; 11:e046630. [PMID: 34404698 PMCID: PMC8372807 DOI: 10.1136/bmjopen-2020-046630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A collaborative service initiative involving community pharmacists and a specialist mental health pharmacist was developed to provide pharmacist reviews for care home residents with intellectual disabilities (IDs). This study aimed to characterise the medicines and lifestyle risk outcomes of the service and determine how these align with national priority issues in ID. DESIGN Descriptive statistical analysis of routinely collected service delivery data. SETTING Residential care homes in the Wirral, England for people with ID. PARTICIPANTS 160 residents. INTERVENTIONS Pharmacist review of residents' medicines and lifestyle risk factors between November 2019 and May 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Numbers of medicines prescribed, the nature of pharmacists' interventions/recommendations and general practitioner (GP)/psychiatrist acceptance. RESULTS The 160 residents were prescribed 1207 medicines, 74% were prescribed ≥5 medicines and 507 interventions/recommendations were made, averaging 3.3 per resident. The highest proportion (30.4%) were lifestyle risk related, while changing and stopping medicines accounted for 17.9% and 12.8%, respectively. Of the recommendations discussed with GPs/psychiatrists, 86% were accepted. Medicines with anticholinergic properties were prescribed for 115 (72%) residents, of whom 43 (37%) had a high anticholinergic burden score. Pharmacists recommended anticholinergic discontinuation or dose reduction for 28 (24%) residents. The pharmacists made interventions/recommendations about constipation management for 10% of residents and about respiratory medicines for 17 (81%) of the 21 residents with respiratory diagnoses. CONCLUSIONS The findings indicate considerable polypharmacy among the residents and a high level of pharmacists' interventions/recommendations about medicines and lifestyle risk, most of which were accepted by GPs/psychiatrists. This included anticholinergic burden reduction and improving respiratory disease and constipation management, which are national priority issues. Wider adoption of collaborative pharmacist review models could have similar benefits for residential populations with ID and potentially reduce pressure on other health services.
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Affiliation(s)
- Nick Thayer
- School of Pharmacy and Bioengineering, Keele University, Newcastle-under-Lyme, Staffordshire, UK
- Community Pharmacy Cheshire and Wirral, Runcorn, Cheshire West and Chester, UK
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | - Jasmeen Islam
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, Cheshire West and Chester, UK
| | - Wesley Jones
- Community Pharmacy Cheshire and Wirral, Runcorn, Cheshire West and Chester, UK
- Boots UK Ltd, Nottingham, UK
| | - Stephanie Kenzie
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, Cheshire West and Chester, UK
| | - Rajni Kullu
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, Cheshire West and Chester, 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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