Feasibility of Integrating Residential Care Pharmacists into Aged Care Homes to Improve Quality Use of Medicines: Study Protocol for a Non-Randomised Controlled Pilot Trial.

Nicole Mcderby,Mark Naunton,Sam Kosari,Alison Shield,Kasia Bail

doi:10.3390/ijerph15030499

Nicole Mcderby, Mark Naunton + Show 3 more

Open Access

https://doi.org/10.3390/ijerph15030499

Copy DOI

Abstract

Older adults are particularly susceptible to iatrogenic disease and communicable diseases, such as influenza. Prescribing in the residential aged care population is complex, and requires ongoing review to prevent medication misadventure. Pharmacist-led medication review is effective in reducing medication-related problems; however, current funding arrangements specifically exclude pharmacists from routinely participating in resident care. Integrating an on-site clinical pharmacist into residential care teams is an unexplored opportunity to improve quality use of medicines in this setting. The primary objective of this pilot study is to investigate the feasibility of integrating a residential care pharmacist into the existing care team. Secondary outcomes include incidence of pharmacist-led medication review, and incidence of potential medication problems based on validated prescribing measures. This is a cross-sectional, non-randomised controlled trial with a residential care pharmacist trialled at a single facility, and a parallel control site receiving usual care and services only. The results of this hypothesis-generating pilot study will be used to identify clinical outcomes and direct future larger scale investigations into the implementation of the novel residential care pharmacist model to optimise quality use of medicines in a population at high risk of medication misadventure.

Highlights

Older people residing in residential aged care homes (RACHs) have additional social and organisational factors which further complicate medicines use
The secondary objectives of this pilot project will be to describe the activities performed by the residential care pharmacist (RCP), and identify various clinical and operational opportunities that may fall under the scope of this new pharmacist role, warranting further investigation
The results of this study will be useful for stakeholders in the health and aged care sectors to inform further investigation and possible decision-making about service values

Summary

Introduction

Prescribing in the older population is highly complex. Age-related pharmacokinetic and pharmacodynamic changes lead to variations in drug bioavailability, increased drug sensitivity, and decreased regulatory mechanisms, altering the effects of drug usage from those observed in younger populations [1]. The presence of multiple co-morbidities necessitating multiple medication usage equates to an increased risk of medication misadventure in older adults [1,2]. Advancing age is positively correlated with increased prevalence of chronic disease, and increased number of co-morbidities correlates with increased medication use [3]. Older people residing in residential aged care homes (RACHs) have additional social and organisational factors which further complicate medicines use.

Objectives

Methods

Discussion

Conclusion