Simpler medication regimens for older people receiving care at home

The intervention for this pre-post pilot and feasibility study will be delivered after study entry by a project pharmacist who is accredited to perform Home Medicines Reviews. The pharmacist will aim to deliver the intervention within 14 days of study entry. The first step in the intervention will involve the project pharmacist undertaking medication reconciliation. A preliminary medication history will be compiled by the project pharmacist prior to visiting each participant based on information collected from the participant’s community pharmacy, GP and community-based home care provider by the research nurse. This information will be verified by the project pharmacist during a participant interview to ensure any medications independently managed by the participant and not included on the community pharmacy, GP or community-based home care provider list are included in the final version of the ‘best possible medication history’ prepared by the project pharmacist. The second step in the intervention will involve the project pharmacist assessing the participant’s ability to self manage their own medication regimen by applying the Drug Regimen Unassisted Grading Scale (DRUGS). The DRUGS criteria will be scored by the project pharmacist in accordance with published literature and the resulting score will be expressed as a percentage to provide a numerical score on a scale of 0 to 100. If after applying the DRUGS criteria the project pharmacist believes the participant does not have sufficient capacity to self-manage the participant’s medication regimen this will be brought to the attention of a registered nurse employed by the community-based home care provider. After discussing with the registered nurse, the project pharmacist may contact the participant’s regular GP and pharmacist to discuss management strategies if the participant is self-managing part or all of their medication regimen and the pharmacist believes the participant does not have sufficient capacity to do so. The third step in the intervention will involve the application of a five-step, implicit structured tool to identify opportunities to reduce medication complexity. The pharmacist will use a modified version of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) to determine whether the participant’s medication regimen may be simplified. Strategies for medication simplification may include a change in medication administration time, formulation (e.g. switching to a combination product or slow release preparation) or active ingredient. It is anticipated the home visit will take approximately one hour. The project pharmacist will then prepare a written report for the community-based home care provider that includes the reconciled ‘best possible medication history’ and a ‘medication management statement’ comprising assessments of adherence, capacity to self-manage and recommendations for simplification. The project pharmacist will then discuss the opportunity for regimen simplification with a registered nurse employed by the community-based home care provider. After discussing with the registered nurse, the project pharmacist may contact the participant’s regular GP and pharmacist where necessary to discuss strategies for simplifying the medication regimen. Recommended changes in medication administration times will be approved by the registered nurse employed by the community-based home care service providing care to the participant or the participant’s GP prior to implementation. The GP will have the opportunity to review all other recommended simplification strategies before implementation and adjust the medication regimen accordingly.