Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method.

João R Gonçalves,Manuel J Lopes,Betsy L Sleath,Afonso M Cavaco

doi:10.3390/pharmacy9040194

Abstract

Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as ‘appropriate’, ‘uncertain’, or ‘inappropriate’ a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as ‘appropriate’ for pharmacy practice targeted to long-term care patients, while 3 were classified as ‘inappropriate’. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.

Highlights

Long-Term Care (LTC) encompasses a range of healthcare, personal care, and other supportive services targeted to patients whose capacity for self-care is limited over an extended period [1,2]
This study aimed to identify the most suitable Prescribing-Assessment Tools useful for LTC pharmacy practice
These Prescribing-Assessment Tools seem to have the potential to be helpful for LTC patients during the transition of care

Summary

Introduction

Long-Term Care (LTC) encompasses a range of healthcare, personal care, and other supportive services targeted to patients whose capacity for self-care is limited over an extended period [1,2]. The National Network for Long-Term Integrated Care (NLTIC) comprehends Home and Community-Based Services (outpatient settings) and Skilled Nursing Homes (inpatient settings). National Network for Long-Term Integrated inpatient settings is divided into ‘Convalescence units’, ‘Medium. Not explicitly targeted to care for aged people, LTC populations are often elderly patients. All previous reasons might explain the high prevalence of Potentially Inappropriate Medication (PIM) in older patients [8,9]. A recent systematic review identified a prevalence of inappropriate medication use among the elderly ranging from 11.5% to

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