Pharmacist-led medication reviews for older care home residents: Are we delivering person-centred care?

Problem

National policy and guidance in England has identified Pharmacists as having a pivotal role in medications optimisation for care home residents with complex polypharmacy. National guidance advocates a person-centred approach to the review and optimisation of patient’s medications. Despite this, studies looking at reviewing and stopping medication rarely include patient orientated outcomes such as patients’ goals and preferences regarding medication. There is no consensus regarding a definition for person-centred care, and research suggests that healthcare professionals may wrongly perceive that they are delivering it. The complexities of person-centred medicines optimisation arise at the boundaries between multiple influential factors: the pharmacist; local context and resources supporting the review process, and the patient and their family. By exploring all three factors, this research study aims to develop a deeper understanding of what person-centred care means in the context of medication reviews in the care home environment, and the barriers and enablers to achieving a person-centred approach in practice.

Approach

This qualitative based study uses individual semi-structured interviews across three phases. Phase one involves interviews with pharmacists conducting care home medication reviews for older residents. Participant recruitment is via local and national care home pharmacist networks acting as gatekeepers and by snowball recruitment from identified participants. A total of 20-30 interviews will be conducted with pharmacists until it is established that no new data are emerging and saturation is reached. Interviews will be conducted virtually by Microsoft Teams or via telephone. Audio transcribed interviews will be coded and thematically analysed supported by NVivo software. Subsequent phases will include case studies with four care home sites, and interviews with care home residents and their family members to discuss their experiences, goals and preferences regarding medication use and review.

Findings

Early themes emerging from phase 1 explore what person-centred care means in the context of care home medication reviews and identify multiple internal and external factors relating to the pharmacist, local context and resources supporting the review process, and the resident or family, which are perceived as barriers and enablers to achieving a person-centred approach to medication reviews for older care home residents. A key finding is that communication is described as complex and an enabling and limiting factor in terms of medication reviews. These barriers and enablers will be described and discussed.

Consequences

Pharmacist-led mediation reviews in care homes is an expanding and developing role within primary care. Learning from the experiences of pharmacists and other stakeholders in the review process will enable the development of a better understanding regarding the barriers and enablers to achieving a person-centred approach. This will support the development of resources to facilitate the inclusion of resident's medication use goals and preferences in the review process and ultimately improve their care.