Pharmacist interventions can improve medication safety for older care home residents, study finds

A pioneering study has synthesised evidence of the effectiveness of pharmacist-led interventions to reduce adverse drug events in older people living in care homes.
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Pharmacist-led interventions can reduce the incidence of adverse drug events in older people living in care homes, a systematic review has suggested.

The researchers described the study as the first of its kind to synthesise evidence of the efficacy and effectiveness of several pharmacist-led interventions to reduce adverse drug events in older people in residential care homes.

They divided 23 studies into 2 groups of interventions: 7 exploring single-component interventions and 16 looking at multicomponent interventions. The most frequent single-component pharmacist-led intervention was medication review and the most common components in multicomponent interventions were medication review and education of healthcare professionals.

Ten of the studies reported significant reductions in adverse drug events following pharmacist-led interventions, either as a sole intervention or as part of a multicomponent intervention. Almost 40% of interventions were focused on reducing the incidence of falls.

The remaining studies showed no effect of pharmacist-led interventions on adverse drug events, which led the authors to suggest that there was a need for “targeted and tailored” approaches to prevent medication-related harm in older residents.

Overall, they concluded that there was “clear evidence” on the impact of pharmacist-led interventions to reduce the incidence of cognitive impairment, falls, drug–drug interactions, drug burden index, anticholinergic drug score, Clostridium difficile infections and urinary tract infections.

“Given the high prevalence of ADEs [adverse drug events] and polypharmacy in older people living in RACFs [residential aged care facilities], pharmacist interventions to improve medication safety in this cohort is of considerable importance,” the authors wrote.

“This review’s findings indicate that pharmacist interventions appear to improve medication safety in RACFs based on observed reductions in ADEs, especially when the provision of care involves a combination of strategies and collaboration with other healthcare providers,” they added.

“Older people in care homes are more likely to have multiple long-term conditions, be living with frailty, prescribed ten drugs or more and drugs with a high burden index (e.g. anticholinergics, sedatives),” explained Lelly Oboh, a consultant pharmacist for older people at Guy’s and St Thomas’ Hospital and the NHS Specialist Pharmacy Service.

“This makes them more vulnerable to ADEs and other drug-related problems such as falls, delirium, constipation and cognitive impairment.”

Oboh said that these adverse drug events were associated with poor outcomes, increased mortality, unnecessary hospitalisation and increased costs.

“Several studies have attempted to identify if, and what, pharmacist-led interventions reduce ADEs in this patient group, but this has proved difficult for many reasons.”

She said that the findings of the study were “significant” with the current move towards “values-based care” that aims to improve patients’ quality of life.

“In frail patients with multi-morbidities, improving function, symptom control and avoiding geriatric syndromes, such as falls and delirium, may matter more to patients than mortality or survival,” she said.

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Citation
The Pharmaceutical Journal, April 2021;Online:DOI:10.1211/PJ.2021.1.79281