Deprescribing of Medicines in Care Homes—A Five-Year Evaluation of Primary Care Pharmacist Practices

Abstract

(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines.

Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS)

“…This activity reduced the drug burden for the resident and led to the clearer MARs charts reported by care home staff. Previous studies have also reported increased safety of medicine administration when a pharmacist has undertaken medication review [ 29 , 30 ].…”

Barriers and enablers to deprescribing in people with a life-limiting disease: A systematic review

“…[31][32][33][34][35][36][37][38][39][40][41][42][43] Full-text screening of those 13 records resulted in the exclusion of 8 articles because they did not meet the inclusion criteria. [31][32][33][34][35][36]38,43 The remaining five articles were included in this review. 37,[39][40][41][42] Checking the cited and citing references of the included studies in Web of Science did not lead to any additional studies, nor did the hand search in Drugs & Aging and JAGS.…”

The Contribution of Pharmacists and Pharmacy Technicians to Person-Centred Care within a Medicine’s Optimisation in Care Homes Service: A Qualitative Evaluation

“…This is a complex and diverse area of practice where knowledge of dementia, pain, and antipsychotic and cardiovascular medication is combined with the assessment and provision of the service and contextualized in relation to effective multidisciplinary working and care home staff training. The clinical reasoning associated with complex case management and medicines review requires knowledge, skills, and experience that are not well codified within pharmacy practice [ 15 ].…”

“…Further acknowledgement and education involving stakeholders may be helpful for practitioners working in the community and in the care home sector [ 15 , 21 ]. As indicated in the policy development and more recently supported within the Enhancing Health in Care Homes report (NHSE 2020), the presence of a pharmacist as a ‘trusted’ and knowledgeable professional, supports a key quality improvement indicator for care homes.…”