Programme to improve the use of drugs in older people and involve general practitioners in community education

Abstract

As part of a multi-pronged approach to improving the quality of drug use in the elderly, a pharmacist was contracted by the Division of General Practice (Northern Tasmania) to develop educational material and implement two academic detailing sessions for general practitioners on the issues of adverse drug reactions and drug interactions in older people. The project aimed to involve general practitioners in community education after optimizing relevant therapeutic knowledge and standardizing prescribing practices. Sixteen general practitioners were involved in the project and 13 of these agreed to participate in academic detailing. The pharmacist developed prescribing guidelines for general practitioners and discussed these and illustrative case studies at the academic detailing sessions. General practitioner-conducted education sessions were completed by nine general practitioners to groups of carers, general practitioners, nurses and older people. Despite the relatively low numbers of general practitioners involved, the results of the project were encouraging. Academic detailing by the pharmacist was well received by the general practitioners, who indicated they would be willing to participate in further sessions. Pre- and post-project multiple-choice tests on therapeutic issues in the elderly indicated a strong trend for an increase in knowledge. Analysis of general practitioners' patient records found a statistically significant decline in the median number of medications prescribed per patient during the project. There was also a statistically significant decline in prescribing of 'indicator' medications, particularly psychoactive drugs and nonsteroidal anti-inflammatory drugs in patients resident in nursing homes. The project demonstrated that academic detailing by a pharmacist can be effective as part of a combined approach to improve the quality of drug use in older people.

Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study

“…For >20 years, specialist clinical pharmacists have worked with general practices, GPs, and practice nurses to achieve improvements in patient care via clinical medication review and prescribing cost-efficiencies across the UK, North America, and Australasia. [7][8][9][10]12,13,15,16 Maintaining these gains, and delivering nWOW and expanded pharmacist services, will be a challenge against a background of medicines shortages, large and sharp increases in drug prices, and funding constraints. [27][28][29] As with other professions, challenges exist in recruiting pharmacists to general practices in rural areas.…”

“…14 Similar initiatives have evolved in North America and Australia. 8,15,16 In the main, UK prescribing teams predominantly consist of specialist clinical pharmacists and pharmacy technicians; however, there are large variations in where, how, and what services are provided. In part, this is due to differences in funding models, local and national agendas, and pressures on current systems and services.…”

The relevance of educating doctors, pharmacists and older patients about potentially inappropriate medications

“…As a result, the proportion of older patients using at least one psychoactive agent was reduced to 65 % after the education phase compared to 80 % before the project [18]. Similarly, CE on appropriate geriatric prescribing appears to improve pharmacists' performance in older people care.…”

Medication review for the older person

“…One randomized controlled trial infers that pharmacists with specialized training could reduce medical costs, 35 whereas three randomized controlled trials found that pharmacist-led medication review led to negligible changes in costs. Further difficulties are created by the lack of competent economic analyses on the value and contribution of pharmacy-led medication review to the medication management of older people.…”