Pharmacists’ roles in nursing homes in Malaysia

Abstract

The Malaysian population is aging, and it is estimated that, by 2020, 3.3 million people will be aged ≥60 years.1 The consequent increase in chronic diseases means increased demand for health services, the use of medicines and the coordination of care for older people. Although medications increase survival and improve quality of life, medication errors can occur.2, 3 Medication-related harm is an ongoing, significant issue in all sectors of health care. Studies have shown that nursing home residents experience adverse events due to inappropriate prescribing practices and inadequate monitoring.4 Pharmacists’ involvement in nursing homes has the potential to minimise medication-related problems and prevent potential medication-related harm and hospitalisations. Studies showed that one-half of nursing home residents are exposed to adverse drug events, duplication of therapy and drug interactions.5 We conducted an exploratory study to examine pharmacists’ attitudes towards the care of older people and their views on the role of pharmacists in Malaysian nursing homes. The study was a prospective, cross-sectional survey conducted from September to October 2015 with pharmacists in Malaysia. The study was approved by the Monash University Human Research Ethics Committee (CF15/791-2015000358). In all, 41 pharmacists responded to the survey. Most (73%) were 20–29 years of age and female (71%), and 77% indicated that they had never had any interactions with nursing home staff relating to pharmacist activities. Many (85%) agreed that pharmacists should have a more active role in nursing homes, whereas 60% agreed that it was an area of health care they would like to practice in. Many (81%) agreed with the statement ‘I tend to pay more attention and have more sympathy for the elderly than younger patients’, and 42% agreed that ‘most older people are pleasant to be with’, whereas 47% responded neutrally to the latter statement (Table 1). With regard to proposed roles for pharmacists in nursing homes, respondents agreed that pharmacists should dispense medications (89%), provide advice on methods of administering medicines (97%), provide advice to prescribers regarding the selection of drug therapy (97%), provide drug information and education directly to patients and nursing home staff (100%), identify patient medication issues and adverse drug reactions that are not being recognised (100%) and undertake medication reviews (100%). Pharmacists, through their training and skills, are ideally placed to perform a medication review and identify medication-related problems. The results of the current survey suggest that most pharmacists believe that better utilisation of their skill-set would be of significant benefit to nursing home residents and their providers. Indeed, many expressed enthusiasm for extending their roles to include the provision of services in nursing homes. A Malaysian study suggested that management of the quality use of medicines (QUM) in nursing homes is inadequate, with an average of 6.1 medication-related problems for every resident.7 The provision of pharmacist services could help reduce excessive medication usage, improve quality of care and decrease costs of medication use and wastage. Pharmacists could also be involved in medicines policy development and education for nurses and physicians. However, before these initiatives can be effectively implemented, it is important that pharmacists in Malaysia undertake further training on geriatric therapeutics and medication reviews. This study highlights a potential new role for appropriately trained pharmacists within the healthcare system to improve medication use in the nursing home setting. No funding was received for this study. The authors declare that they have no conflicts of interest. All authors contributed to the study concept and design, data collection, analysis, interpretation of data and preparation of manuscript.