None listed
Conditions
Brief summary
The proportion of older Australians is increasing, in parallel to increasing multimorbidity, polypharmacy and an increased risk of Adverse Drug Events (ADEs). The Drug Burden Index (DBI) is a pharmacologic risk assessment tool that measures an individual’s total exposure to anticholinergic and sedative medications. A high DBI score is associated with poor clinical outcomes in older adults. Home Medicines Review (HMR) is a comprehensive medication review service involving a pharmacist, general practitioner (GP) and the patient with the aim of enhancing quality use of medicines and reducing ADEs. To date, the DBI has not been tested in the HMR setting. AIMS: (1) To assess if the DBI report is feasible as a risk assessment tool in this setting; (2) To establish whether the DBI together with HMR service can reduce use of anticholinergic and sedative medications in older adults; (3) To assess changes in clinical outcomes in older adults following reduction of anticholinergic and sedative medications. Methods: An interventional feasibility study with two arms will be conducted: 10-20 pharmacists, who regularly conduct HMRs in the community, will be recruited to participate in the study. Each pharmacist will undergo an education program and be provided access to the Drug Burden Index Calculator 'Copyright'. Each pharmacist will also provide anonymous data on HMRs conducted for 10 patients to serve as historical controls. The intervention will involve pharmacists providing a DBI report to GPs with the HMR service for 10 patients. Patients will be asked to fill in a questionnaire, and be contacted by telephone for an interview at 0 and 3 months (post-HMR) by lead investigator to assess cognition and physical function. Discussion: Results from this study will provide an evaluation of the utility of the DBI as a risk assessment tool for reducing inappropriate prescribing in older adults during a HMR; and set the groundwork for a larger randomised control study.
Interventions
Drug burden index is a tool used to quantify a person’s total exposure to anticholinergic and sedative medications. Drug burden index has been associated with physical and cognitive performance in older people. Drug burden index can be used to assess the risks and benefits of prescribing for older populations.
Home Medicines Review (HMR) is a comprehensive medication review service involving a pharmacist, general practitioner (GP) and the patient with the aim of enhancing quality use of medicine
Drug burden index is a tool used to quantify a person’s total exposure to anticholinergic and sedative medications. Drug burden index has been associated with physical and cognitive performance in older people. Drug burden index can be used to assess the risks and benefits of prescribing for older populations. Home Medicines Review (HMR) is a comprehensive medication review service involving a pharmacist, general practitioner (GP) and the patient with the aim of enhancing quality use of medicines and reducing ADEs. To date, the DBI has not been tested in the HMR setting. Aims: (1) To assess if the DBI report is feasible as a risk assessment tool in this setting; (2) To establish whether the DBI together with HMR service can reduce use of anticholinergic and sedative medications in older adults; (3) To assess changes in clinical outcomes in older adults following reduction of anticholinergic and sedative medications. The Interventions Pharmacist education sessions on medication use in older adults - The education session is 2 hours long. The education session will be conducted by the research team who have expertise in clinical pharmacology, pharmacy and geriatrics. The research team documents attendance to the education session by return completion of a questionnaire form. After the education session, each pharmacist will conduct 10 HMRs with 10 different patients incorporating the DBI into the HMR report to the GP. This will be monitored by copies of the HMR + DBI reports together with the relevant patient information returned to the research team.
Sponsors
University of Sydney
Study design
Allocation
Non-randomised trial
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Pharmacists *Current registered Australian pharmacist *Current accreditation to conduct HMRs *Have conducted at least 10 HMRs in the last 1-2 years *Will be able to complete 10 HMRs in the next 3 months *Able to attend an information day at University of Sydney Patients *Aged greater than or equal to 65 years *Can speak English and is able to conduct a telephone interview *Eligible for a HMR *Able to provide informed written consent (Patient or carer)
Exclusion criteria
unable to obtain informed consent from pharmacists or patients
Outcome results
None listed