Optimisation of medication in older persons

Abstract

Optimisation of medication in older patients is challenging and explicit criteria assist in the identification of pharmaceutical care issues enhancing pharmacist intervention. The aim of the research was to assess the feasibility and applicability of clinical tools adopted by pharmacists to optimise patients’ pharmacotherapy in a community pharmacy setting using a collaborative care approach. The study was carried out on a sample of 80 patients in a community pharmacy setting. Two inclusion criteria were identified: patients ≥65 years and taking ≥3 medications. Patients were selected by convenience sampling from one community pharmacy. The GheOP³S¹ tool was applied to identify pharmaceutical care issues which were assessed by the researcher to identify necessary interventions. A tool was developed for the documentation of the pharmacist interventions. Pharmacist sessions were carried out either face-to-face or through telephone and patients were followed up after 2 months. A sample of three case studies having the most frequent pharmacist interventions were selected for validation of pharmacist intervention by an expert group, consisting of 3 community pharmacists and 3 general practitioners. A high level of agreement with the pharmacist interventions was demonstrated by the expert panel, validating the pharmacist interventions from a clinical relevance perspective. The mean number of medications the patients were taking was 7 (range 3-16). The mean interview time was 11 minutes for face-to-face interviews and 12 minutes for telephone interviews. Through the GheOP³S tool, the pharmacist identified 254 pharmaceutical care issues: 61% of the care issues concerned general care-related items, 13% related to potential prescribing omissions and 10% were associated with drug-drug interactions. The pharmacist carried out 190 interventions: 41% of the interventions dealt with checking the medication adherence of patients, 13% concerned patient education about a specific condition or medication and 12% were specific to influenza vaccine recommendations. The pharmacist interventions were fulfilled with a 79% implementation rate. The study confirmed that remote clinical pharmacy services in primary care were effective at identifying care issues and implementing relevant pharmacist recommendations. The application of the GheOP³S tool in conjunction with the developed data collection tool was feasible and applicable in the community pharmacy context. The tools identified pertinent care issues and facilitated a standardised pharmacist intervention. The developed data collection tool ensures appropriate documentation and follow-up of the proposed interventions.