School of Pharmacy and Bioengineering, Keele University, Newcastle-under-Lyme, Staffordshire, UK
Community Pharmacy Cheshire and Wirral, Runcorn, Cheshire West and Chester, UK.
BMJ Open. 2021 Aug 17;11(8):e046630. doi: 10.1136/bmjopen-2020-046630.
A collaborative service initiative involving community pharmacists and a specialist mental health pharmacist was developed to provide pharmacist reviews for care home residents with intellectual disabilities (IDs). This study aimed to characterise the medicines and lifestyle risk outcomes of the service and determine how these align with national priority issues in ID.
Descriptive statistical analysis of routinely collected service delivery data.
Residential care homes in the Wirral, England for people with ID.
160 residents.
Pharmacist review of residents' medicines and lifestyle risk factors between November 2019 and May 2020.
Numbers of medicines prescribed, the nature of pharmacists' interventions/recommendations and general practitioner (GP)/psychiatrist acceptance.
The 160 residents were prescribed 1207 medicines, 74% were prescribed ≥5 medicines and 507 interventions/recommendations were made, averaging 3.3 per resident. The highest proportion (30.4%) were lifestyle risk related, while changing and stopping medicines accounted for 17.9% and 12.8%, respectively. Of the recommendations discussed with GPs/psychiatrists, 86% were accepted. Medicines with anticholinergic properties were prescribed for 115 (72%) residents, of whom 43 (37%) had a high anticholinergic burden score. Pharmacists recommended anticholinergic discontinuation or dose reduction for 28 (24%) residents. The pharmacists made interventions/recommendations about constipation management for 10% of residents and about respiratory medicines for 17 (81%) of the 21 residents with respiratory diagnoses.
The findings indicate considerable polypharmacy among the residents and a high level of pharmacists' interventions/recommendations about medicines and lifestyle risk, most of which were accepted by GPs/psychiatrists. This included anticholinergic burden reduction and improving respiratory disease and constipation management, which are national priority issues. Wider adoption of collaborative pharmacist review models could have similar benefits for residential populations with ID and potentially reduce pressure on other health services.
一项涉及社区药剂师和一名精神健康专家药剂师的合作服务计划得以开展，旨在为智障（ID）护理院居民提供药剂师审查。本研究旨在描述该服务的药物和生活方式风险结果，并确定这些结果如何与 ID 的国家优先事项相一致。
对常规收集的服务提供数据进行描述性统计分析。
英格兰威尔拉尔的智障人士居住护理院。
160 名居民。
2019 年 11 月至 2020 年 5 月期间，药剂师审查居民的药物和生活方式风险因素。
开出的药物数量、药剂师干预/建议的性质以及全科医生/精神病医生的接受程度。
160 名居民共开处 1207 种药物，74%的居民开处 5 种以上药物，共提出 507 项干预/建议，平均每名居民 3.3 项。比例最高的是生活方式风险相关（30.4%），其次是药物调整和停药（分别占 17.9%和 12.8%）。在与全科医生/精神病医生讨论的建议中，86%被接受。有 115 名（72%）居民开处具有抗胆碱能特性的药物，其中 43 名（37%）具有较高的抗胆碱能负担评分。药剂师建议停止或减少 28 名（24%）居民的抗胆碱能药物。药剂师针对 10%的居民的便秘管理提出干预/建议，针对 21 名有呼吸道疾病的居民中的 17 名（81%）的呼吸道药物提出建议。
研究结果表明，居民中存在大量的药物并用，且药剂师对药物和生活方式风险提出了大量干预/建议，其中大部分得到了全科医生/精神病医生的认可。这包括降低抗胆碱能负担和改善呼吸道疾病和便秘管理，这些都是国家优先事项。更广泛地采用合作药剂师审查模式可能会为智障人群居住护理院带来类似的益处，并可能减轻其他卫生服务的压力。
