Development of a framework to support the design and evaluation of Pharmacist led medicines optimisation in Care Homes – a local validation

Problem

Older people are the major users of medication. In the last 20 years there has been a dramatic increase in the prevalence of polypharmacy with the number of older people taking five or more medicines increasing from 12% to nearly 50%. Medicines optimisation is thus challenging in older people and can be particularly challenging in older people in Care Homes where there is a high prevalence of dementia.Wolverhampton CCG has been supporting medicines optimisation in Care Homes for a number of years via a series of initiatives all of which aim to reduce the problems associated with inappropriate polypharmacy, reducing medication errors, adverse drug interactions, difficulty in taking medications as directed and supporting medicines management within care homes.The aim of this service evaluation project was to develop a framework to support the design and evaluation of Pharmacist led medicines optimisation in Care Homes.

Approach

The framework, for pharmacist-led medicines optimisation, was developed in a four-stage process: Stage 1: Establishment of a Core Project Team and a Consultative GroupN= 11 (local clinicians (doctors, pharmacists/pharmacy technicians, nurses) and a care home manager) to support evaluation of the framework during its developmentStage 2: Development of a first draft of the frameworkKey elements for the framework were developed by the Core Team (AH, NS, IM) from current literature, previous research and service evaluations undertaken by the CCG and Aston University. Several iterations were developed Stage 3: Evaluation of the first draft of the framework by the Consultative GroupThe Consultative Group evaluated every element of the draft framework providing quantitative data and free-text qualitative comments. Elements of the framework were rated using a six-point scale of (5) Essential (4) Highly recommended, (3) Recommended (2) Desirable, (1) Desirable if possible (0) Remove. Stage 4: Analysis of the data from the evaluation by the Consultative Group

Findings

Elements with a mean rating of two or less (N = 12) were reviewed by the Core Team. Along with the qualitative comments. Qualitative comments on the framework were analysed. Key amendments were made: Using full Primary Care record rather than a summaryRemoval of any duplication notificationsTo include information on vital physical signs and other clinical assessmentsFurther to this, other general themes included the need to involve A) GP’s B) care home staff C) residents/family carers at key stages

Consequences

We have evaluated/validated a local framework to support a pharmacist led model for medicines optimisation in care homes. The next steps include validating the framework to reflect different models across the UK with a national survey of health professionals and a qualitative study investigating the engagement of residents and family carers.