Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
School Healthcare, University of Leicester, Leicester, UK.
BMJ Open. 2023 Oct 31;13(10):e068678. doi: 10.1136/bmjopen-2022-068678.
Older people in care homes frequently experience polypharmacy, increasing the likelihood of medicine-related burden. Pharmacists working within multidisciplinary primary care teams are ideally placed to lead on medication reviews. A randomised controlled trial placed pharmacists, with independent prescribing rights (PIPs), into older people care homes. In the intervention service, PIPs worked with general practitioners (GPs) and care home staff for 6 months, to optimise medicine management at individual resident and care home level. PIP activity included stopping medicines that were no longer needed or where potential harms outweighed benefits. This analysis of qualitative data examines health and social care stakeholders' perceptions of how the service impacted on care home medicine procedures and resident well-being.
Pragmatic research design with secondary analysis of interviews.
Primary care pharmacist intervention in older people care homes in England, Scotland and Northern Ireland.
Recruited from intervention arm of the trial: PIPs (n=14), GPs (n=8), care home managers (n=9) and care home staff (n=6).
There were resonances between different participant groups about potential benefits to care home residents of a medicine service provided by PIPs. There were small differences in perceptions about changes related to communication between professionals. Results are reported through three themes (1) 'It's a natural fit'-pharmacists undertaking medication review in care homes fitted within multidisciplinary care; (2) 'The resident is cared for'-there were subjective improvements in residents' well-being; (3) 'Moving from "firefighting" to effective systems'-there was evidence of changes to care home medicine procedures.
This study suggests that pharmacist independent prescribers in primary care working within the multidisciplinary team can manage care home residents' medicines leading to subjective improvements in residents' well-being and medicine management procedures. Care home staff appreciated contact with a dedicated person in the GP practice.
ISRCTN 17847169.
养老院中的老年人经常服用多种药物，增加了与药物相关的负担的可能性。在多学科初级保健团队中工作的药剂师最适合负责药物审查。一项随机对照试验将具有独立处方权（PIP）的药剂师安置在老年人疗养院中。在干预服务中，PIP 与全科医生（GP）和疗养院工作人员合作了 6 个月，以优化个体居民和疗养院级别的药物管理。PIP 的活动包括停止不再需要或潜在危害超过益处的药物。这项对定性数据的分析探讨了卫生和社会保健利益相关者对服务如何影响疗养院药物程序和居民福祉的看法。
具有二次分析访谈的实用研究设计。
英格兰、苏格兰和北爱尔兰的老年人疗养院中的初级保健药剂师干预。
从试验的干预组招募：PIP（n=14）、GP（n=8）、疗养院经理（n=9）和疗养院工作人员（n=6）。
不同参与者群体对 PIP 提供的药物服务为疗养院居民带来的潜在益处存在共鸣。关于专业人员之间沟通相关变化的看法存在微小差异。结果通过三个主题报告（1）“这是自然的契合”-药剂师在疗养院进行药物审查符合多学科护理；（2）“居民得到照顾”-居民的幸福感有了主观上的改善；（3）“从‘灭火’到有效的系统”-有证据表明疗养院药物程序发生了变化。
这项研究表明，在多学科团队中工作的初级保健独立药剂师可以管理疗养院居民的药物，从而使居民的幸福感和药物管理程序得到主观改善。疗养院工作人员赞赏与 GP 实践中的专门人员联系。
ISRCTN 17847169。
