Pharmacy support for elderly improves health outcomes
Community pharmacies are able to make significant improvements to medicines adherence and quality of life for older patients who are taking multiple medicines, leading to reductions in falls and better medicines optimisation, a new study shows.
The full results from theÂ Community Pharmacy Future (CPF) projectâ€™s Four or More Medicines (FOMM) Support Service have been published in the peer-reviewed International Journal of Pharmacy Practice. The results show that the service improved medication adherence among patients aged over 65 years old who were taking four or more medicines regularly. Twenty-five pharmacies in Wigan recruited 620 patients for the FOMM service.
Patients registered for the service had a median of three clinical conditions and were taking a median seven (range five to nine) medicines. The most common conditions were cardiovascular, chronic pain, musculoskeletal and coronary heart disease.
As part of the service, pharmacists reviewed patientsâ€™ medication using a subset of STOPP/START criteria. Pharmacists made 142 recommendations to prescribers in relation to 110 patients, largely centred on potentially inappropriate prescribing of non-steroidal anti-inflammatory drugs, proton pump inhibitors or duplications of therapy. Eight of the recommendations were to start medication (either for asthma or bisphosphonates).
After six months of follow-up there was a significant reduction in the total number of medical and self-treated falls experienced by patients and significant increases in medicines adherence (7 per cent improvement on Morisky score) and patient quality of life (measured using EQ-5D). Adherence improved progressively over the course of the evaluation period, with a higher proportion of patients classified as highly adherent at the end of the study.
Patients were assessed to gauge their risk from falls, especially those related to clinical conditions and medicines use. Where appropriate, pharmacists made recommendations to prescribers for changes in medication that might reduce risks. Patients were also given practical advice on changes they could make at home to reduce risks as well as dietary and lifestyle advice. As a result of these discussions, pharmacists picked up on a range of issues being faced by patients, not all of which were medicines related.
During their regular assessments in the pharmacy, patients were offered information to support healthy lifestyles, including advice on weight, smoking and alcohol use.
Speaking on behalf of the CPF project team, Clare Kerr, Head of Healthcare Policy and Strategy, Celesio UK, and a member of the CPF Management Committee, said: â€œOur work has shown that delivering targeted and tailored support for patients when they visit a pharmacy brings real benefits. Improvements in clinical outcome measures translated in to tangible benefits that patients and pharmacists noticed. By reducing falls, pharmacists both saved the NHS money and improved patientsâ€™ confidence in what they were able to do.
â€œWe have also demonstrated that this service can be delivered by pharmacies in a wide range of settings and are very pleased that our CPF work has resulted in this robust addition to the evidence base supporting the commissioning of services from community pharmacies."