Guénette Line, Kröger Edeltraut, Bonnan Dylan, Maheu Anne, Morin Michèle, Bélanger Laurianne, Vedel Isabelle, Wilchesky Machelle, Sirois Caroline, Durand Etienne, Couturier Yves, Sourial Nadia, Dallaire Clémence
Faculty of Pharmacy, Université Laval, Québec, QC, Canada.
Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.
JMIR Res Protoc. 2022 Nov 17;11(11):e42577. doi: 10.2196/42577.
The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults' pharmacotherapy are opening.
This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and support offered to these patients and their caregivers.
This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semistructured interviews (step 2). Older adults undergoing cognitive assessment, recently diagnosed with MNCD, or receiving care for this at home will be identified and recruited in FMGs in 2 Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients' care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided.
Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after 6 months of follow-up and compared between groups. At the end of the intervention study, we will conduct semistructured interviews with FMG care team members (pharmacists, nurses, and physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice and their satisfaction with and their perception of the intervention's impacts for older adults and their families. We will assess the effect of improved pharmaceutical care for older adults with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care.
The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more substantial pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care.
ClinicalTrials.gov NCT04889794; https://clinicaltrials.gov/ct2/show/NCT04889794.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42577.
最新的全球数据显示，2021年全球有5500万人患有重度神经认知障碍（MNCD）。在加拿大魁北克省，这些老年人大多由家庭医生在跨学科初级保健诊所，如家庭医学团队（FMG）中进行护理。当一个人患有MNCD时，服用潜在不适当的药物或多重用药（5种或更多不同药物）会增加他们发生严重不良事件的风险。随着FMG中药剂师的加入以及他们扩大的执业范围和自主权，优化老年人药物治疗的新可能性正在出现。
本项目旨在评估让这些药剂师参与患有MNCD的老年人护理过程的影响，这是与FMG团队、家庭护理护士和医生的跨学科合作。药剂师将提供药物审查、干预措施和建议，以改善对这些患者及其护理人员的药物治疗和支持。
这项分两步进行的混合方法研究将包括一项准实验对照试验（第一步）和半结构化访谈（第二步）。在魁北克的两个地区的FMG中识别并招募正在接受认知评估、最近被诊断患有MNCD或在家中接受此类护理的老年人。实施干预措施的FMG将让药剂师参与这些患者的护理过程。将为这些FMG，特别是药剂师提供培训和定期指导。在对照FMG中，不会有FMG药剂师参与这些患者的护理，将提供常规护理。
在研究开始时和随访6个月后评估药物使用（包括适当性）和负担、所接受护理的满意度以及生活质量，并在组间进行比较。在干预研究结束时，我们将对经历过干预的FMG护理团队成员（药剂师、护士和医生）进行半结构化访谈。我们将询问将干预措施整合到实践中的可行性，以及他们对干预措施对老年人及其家庭的影响的满意度和看法。我们将通过FMG药剂师的参与和药物护理的重组，评估改善对患有MNCD或有MNCD风险的老年人的药物护理的效果。
药剂师纳入跨学科护理团队是最近才出现且呈上升趋势的，更多实质性的药剂师执业角色强化了这一趋势。研究结果将为成功让药剂师参与并实施可应用于其他护理环境的已开发工具和程序以改善患者护理所需的流程提供信息。
ClinicalTrials.gov NCT04889794；https://clinicaltrials.gov/ct2/show/NCT04889794。
国际注册报告识别码（IRRID）：DERR1-10.2196/42577。
