Use of pharmacy services in community-dwelling middle-aged and older adults in Ireland

Abstract

Abstract Introduction Pharmacy has a potentially significant role in meeting the escalating need for healthcare, particularly with population ageing and shifts to more community-based care under Ireland’s health reform policies. The role of community pharmacists has evolved in recent years with expansion in pharmacy services offered. This study aims to assess pharmacy services use among adults aged ≥50 years in Ireland, and determine the demographic and clinical factors associated with pharmacy services use. Methods This cross-sectional study included community-dwelling participants in wave 4 of The Irish Longitudinal Study on Ageing (TILDA), aged ≥50 years who were self-respondents (i.e. proxy respondents were omitted). TILDA is a nationally representative cohort study, and wave 4 data was collected during 2016. TILDA participants were asked if they availed of several named services when visiting the pharmacy in the last 12 months. These included: requesting advice about medication; vaccination; blood pressure (BP) or cholesterol checks; advice on smoking cessation or weight management; and diabetes, asthma, or allergy tests. We considered age, sex, educational attainment, GP utilization, medical card and private health insurance status, loneliness, polypharmacy, use of high risk medications (anticoagulants, NSAIDs, opioids, diuretics, antiplatelets, antimicrobials, insulin and hypoglycaemics) and comorbidities. Multivariate logistic regression was used to examine the association of these with reporting (i) any pharmacy service use and (ii) requesting medicines advice. Results This study included 5,782 participants, 55.5% were female with a mean age of 68 years. 96.6% of participants (5,587) reporting visiting a pharmacy in the previous 12 months, and almost one quarter of these (1,323) availed of at least one specified pharmacy service. The most common services reported were requesting advice about medications (786, 13.6%), blood pressure monitoring (184, 3.2%), and vaccination (166, 2.9%). Compared to those not using any services, service users were a similar age (mean 68 years), but were taking more medications (mean 3.6 versus 2.8), were more often female (64.1% versus 54.2%), had higher educational attainment, and had higher GP visit rates. Controlling for other factors, the following were associated with a high likelihood of availing of pharmacy services: female gender (odds ratio (OR) 1.32, 95%CI 1.14–1.52), third level education (OR 1.85, 95%CI 1.51–2.27), higher rates of GP visits, private health insurance (OR 1.29, 95%CI 1.07–1.56), higher number of medications, loneliness, and a diagnosed respiratory condition (OR 1.42, 95% CI 1.14–1.74). The relationship between these factors and requesting medicines advice were similar. Conclusion A high proportion of middle-aged and older adults visit community pharmacy and a quarter avail of specified pharmacy services. Despite advances in the services offered in pharmacies, medicines advice remains at the core of pharmacists’ practice. Those on multiple medications, who may derive greater benefit from such services, are more likely to avail of them. Number of GP visits was also associated with service use, suggesting patients may avail of pharmacy services as a complement, rather than a substitute, to visiting their GP. Services were more often used by people who are lonely, and pharmacists should consider interventions to support these people.