Community pharmacists\u2019 views of using a screening tool to structure medicines use reviews for older people: findings from qualitative interviews

Karen Cardwell,Carmel M Hughes,Cristín Ryan

doi:10.1007/s11096-018-0659-z

Abstract

Background The Medicines use review (MUR) service, provided by community pharmacists, seeks to optimise patients’ use of medicines. There is limited evidence on the clinical effectiveness of this service. Structuring MURs to include an assessment of prescribing appropriateness, facilitated by a validated prescribing screening tool, has the capacity to enhance this service. Objective To explore community pharmacists’ views on the facilitators and barriers towards the utilisation of a screening tool as a guide to conducting structured MURs. Setting Community Pharmacy, Northern Ireland. Method Using the 14 domain Theoretical Domains Framework (TDF), semi-structured interviews were conducted with community pharmacists. Interviews were digitally recorded, transcribed verbatim and analysed using the Framework method. Main Outcome Measure Pharmacists’ views towards utilisation of a screening tool as a guide to conducting structured MURs. Results Based on the analysis of 15 interviews, 11 TDF domains (‘Knowledge’, ‘Skills’, ‘Social and professional role and identity’, ‘Beliefs about capabilities’, ‘Beliefs about consequences’, ‘Reinforcement’, ‘Goals’, ‘Memory, attention and decision process’, ‘Environmental context and resources’, ‘Social influences’, ‘Behavioural regulation’) were deemed relevant. Facilitators included: knowledge of patients, clinical knowledge, perceived professional role, patients’ clinical outcomes, influence of peers. Barriers included: prioritisation of other clinical activities, inability to access patients’ clinical information, perceived alienation from the primary healthcare team and staffing issues. Conclusions Using the TDF, key facilitators and barriers were identified in the use of a screening tool as a guide to conducting MURs. These findings may assist in further development of MURs as a means to optimise patients’ medicines use.

Highlights

Prescribing for older people is complex, due to the increased likelihood of developing multiple long-term conditions and prescribing of multiple medications [1]
This study provides preliminary data on the barriers and facilitators to utilising a screening tool as part of a Medicines use review (MUR), which may assist in further development of MURs as a means to optimise patients’ medicines use
Polypharmacy is an essential component in the management of multimorbidity, it is associated with several undesirable outcomes such as reduced adherence to prescribed medication, drug–drug interactions and adverse drug reactions (ADRs) [1]; the latter is a particular concern in older people as the process of physiological ageing renders this group more susceptible to ADRs [2]

Summary

Introduction

Prescribing for older people is complex, due to the increased likelihood of developing multiple long-term conditions (multimorbidity) and prescribing of multiple medications (polypharmacy) [1]. The older age group are at an increased risk of potentially inappropriate prescribing (PIP), i.e. the under-, over- or mis-prescribing of medicines, which has been associated with ADRs, hospital admissions and mortality [4]. This has led to the development of a number of screening tools to evaluate the appropriateness of prescribing, e.g. Screening Tool of Older Persons’ Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) [5, 6] and the Beers Criteria [7]. Structuring MURs to include an assessment of prescribing appropriateness, facilitated by a validated prescribing screening tool, has the capacity to enhance this service

Methods

Results

Conclusion