None listed
Conditions
Brief summary
Introduction: Older people in Aged Residential Care (ARC) usually have multiple complex, physical, mental and social needs. Most are on multiple medications (polypharmacy). This is associated with adverse outcomes including falls, fractures, cognitive decline, incontinence and hospital admissions. This study will examine the intervention of a pharmacist-led medication review, guided by a routinely collected prognostic scale, and a frailty score. Methods and analysis: This is a feasibility study. Study population: Participants will be new admissions to long-term residential care in Christchurch. There will be 8 intervention facilities and 4 control facilities. Participants will be approached in the first month after they enter ARC. Intervention: A specialist pharmacist will review medications, guided by patient’s treatment priorities, a prognostic scale (InterRAI CHESS scale) and a frailty index (Reported Edmonton Frailty Score, REFS). Recommendations will be made to GPs, who will make final decisions on any medication changes. Primary outcomes: Number of older people and GPs accepting a medication review. Number of pharmacist recommendation adopted by GPs (measured by number and classes of medications) after three and six months. Secondary outcomes: quality of life at baseline, three and six months. Hospital admissions after 3 and 6 months. Increased level of care after three and six months.
Interventions
Older people entering long-term Aged Residential Care (ARC) for the first time will be recruited. Written and verbal explanations of the study will be provided by a trained research assistant. If the person agrees to participate in the study written consent will be obtained. The research assistant will record a quality-of-life score.
Participants will go through a Medicines Therapy Assessment (MTA) conducted by an accredited pharmacist. This involves the pharmacist reviewing medication records,
Older people entering long-term Aged Residential Care (ARC) for the first time will be recruited. Written and verbal explanations of the study will be provided by a trained research assistant. If the person agrees to participate in the study written consent will be obtained. The research assistant will record a quality-of-life score. Participants will go through a Medicines Therapy Assessment (MTA) conducted by an accredited pharmacist. This involves the pharmacist reviewing medication records, meeting with the participant (and family or other caregiver when appropriate) and discussing their priorities for care and their medications. The assessment will take 45-60 minutes. It will occur as a one-off intervention. The Changes in Health, End-Stage Symptoms and Signs (CHESS) scale is routinely collected as part of the ARC admission process in all older people in New Zealand. This is a prognostic indicator with scores from 0-5, higher scores indicating poorer prognosis. The pharmacist will also consider this score. The pharmacist will then develop individualised recommendations based on admission medications, participants priorities and potential prognosis. Detailed recommendations will be provided to the participants regular GP, by personal visit, phone call, email or letter as preferred by the GP. The GP will be responsible for making any medication changes. There will be no additional follow-up with the GP after the initial assessment and recommendations are made. After 3 and 6 months the research assistant will review number and classes of medications and repeat the quality-of-life scale again.
Sponsors
Claire Heppenstall
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Aged over 65 years (55 y for Maori). Moving to long-term Aged Residential Care for the first time. On four or more medications.
Exclusion criteria
Palliative or terminal care On three or less medications In ARC for short stay respite or rehabilitation and expected to return to their own home.
Outcome results
None listed