Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults

Abstract

Objectives: This pilot study examines effectiveness of an innovative pharmacy design change on over-the-counter (OTC) medication misuse in older adults (ages over 64). Few interventions have attempted to decrease older adult OTC misuse, and none have addressed system barriers. A structural redesign of the pharmacy (the Senior Section) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications (for pain, cough/cold, allergy, sleep) and is close to the prescription department to facilitate pharmacy staff/patient engagement to reduce misuse. Methods: A pre-/post-implementation design was used to recruit 87 older adults from three pharmacies. Using a hypothetical scenario, participants selected an OTC medication, which was compared to their medication list and health conditions, and their reported use was compared against the product labeling. Four misuse outcomes were determined: (1) Drug/Drug, (2) Drug/Disease, (3) Drug/Age, and (4) Drug/Label with five sub-types. Patient characteristics were collected and compiled into a propensity-score matching logistic regression model to estimate their effects on the Senior Section's association with misuse outcomes at pre-/post-implementation. Results: Patient characteristic were uniform between pre-/post-implementation and, once entered into a propensity-score matching model, Drug/Disease Misuse significantly lessened over time (z=-2.09, p=0.037). The Senior Section reduced Drug/Drug Misuse, but not significantly. Drug/Label Misuse varied according to the sub-type, with reduced Daily-Dosage (z=-2.42, p=0.016) and Single-Dosage misuse (z=-5.82, p=0.001); however, Timing/Frequency misuse increased (z=2.16, p=0.031). Conclusions: These nascent outcomes support a well-conceived pharmacy-based OTC aisles redesign as valuable for reducing older adult OTC medication misuse. The Senior Section, when broadly implemented, would create new permanent structures and processes to assist older adults in accessing risk information for confidently selecting safer OTC medications.