A pharmacist-led medicines review intervention in community-dwelling Maori older adults– a feasibility study.

Intervention: Pharmacist-led medicines review service with 2 components: a) medicines education and b) medicines optimisation (optional). Intervention Intervention Content and Delivery Medicines education preparation The lead investigator will be the pharmacist delivering the intervention. The pharmacist will access the participant’s medicines dispensing history prior to medicines education meeting (unless the participant has specified they do not want the pharmacist to access this level of information prior to the medicines education component). For medicines education to be able to be delivered, an accurate list of participant’s medicines is required. Obtaining an accurate list of medicines taken is known as the process of medicines reconciliation and requires use at least two sources, one of which can be the list of dispensed medicines. A list of dispensed medicines will be obtained by accessing the dispensing history on Testsafe™(accessed via the WDHB Clinical Portal) which is an online repository which includes dispensed medicines. All community pharmacies who dispense medicines to patients in WDHB send information through to this repository. The pharmacist has access to this system via employment with WDHB. The second source for medicines reconciliation will be the participant during the medicines education component. Medicines education component The pharmacist and participant will discuss medicines that the participant is taking as well as medicine-related needs and goals for overall well-being. The inclusion of discussions relating to goals allows the participant to identify areas that may be relevant in regards to tailoring the education and also allows for whanaungatanga (development of connections) between the participant and the pharmacist. The pharmacist will schedule a time for this component either at the time of consent or via telephone or email correspondence. It is intended that this will happen as soon as practicable after consent is gained (but after baseline data has been collected by the independent research assistant). Interactions will be governed by principles of kaupapa Maori research with a focus on exerting the participant’s right to rangatiratanga (self-determination and control). The session will centre on allowing time and space to talk about medicines and to improve the participants’ understanding of what the medicines are used for, potential side effects and likely length of treatment as well as improving the lead investigator’s understanding of what is important to the participant. Participants will be asked to bring their medicines along to the education session to guide discussions. It is intended that the discussions will be guided by what the patient identifies as priority areas for discussion. This component will include tasks to the level of Medicines Use Review (MUR) in the PSNZ NZ National Pharmacist Services Framework. It may additionally include aspects described under Medicines Therapy Assessment (MTA) in relation to identifying participant concerns relating to medicines effectiveness or ADRs and discussion of medicines in the context of participant-identified goals of therapy. Information relevant to the medicines education component will be collected on the Medicines Education Data Collection Form. Information will be summarised and sent as a narrative summary to the participant’s primary prescriber and community pharmacy either via post or secure electronic mail. This aspect of the intervention allows for connected communication between those involved in provision of health care to the participant. Medicines Optimisation Preparation (optional) Prior to the meeting the Pharmacist will access the participant’s clinical information via the WDHB Clinical Portal which is an online repository allowing access to medicine dispensing data, laboratory investigations, secondary care referrals and appointments, inpatient clinical observations, allied health assessments and publicly-funded hospital discharge summaries and outpatient clinic letters. This information, in addition to the conversation had both in the medicines education component and the medicines optimisation meeting will be used to review medicines appropriateness in relation to the individual participant. The information will be collected on the Medicines Optimisation Component Form. In the Phase 1b interviews, Maori older adults and health professional participants had mixed views on whether clinicians whom ‘patient’ participants had not met, should access their clinical information. As rangatiratanga (self-determination, control) is one of the aspects important in the proposed service model, it was decided to place the clinical history preparation after medicines education component (as the participant has met with the pharmacist). Medicines Optimisation Component (optional) The pharmacist will arrange a time to meet with the participant and primary prescriber (likely to be a GP but may include nurse practitioners or other designated prescribers). The medicines optimisation component will be delivered in line with the medicines management services described under Medicines Therapy Assessment (MTA) and Comprehensive Medicines Management (CMM) in the PSNZ Pharmacist Services Framework and the guidance set out in the Royal Pharmaceutical Society of Great Britain’s Medicines Optimisation good practice guidance. If the prescriber is unable to be present at the medicines optimisation meeting then the pharmacist and prescriber will arrange a way to communicate the discussion (i.e. face-to-face at another point in time, over telephone or secure electronic transfer of information). The participant will be informed that the alternative route of communication is to be used. For example, the pharmacist may send a written communication to the prescriber, detailing the discussion with the participant and recommendations arising from the medicines optimisation component of the intervention. The prescriber and participant would then be able to arrange a time to discuss this further. The final output of the medicines optimisation component will be the development of a medicines management plan that has been agreed by the participant, prescriber and pharmacist. To clarify, the medicines optimisation component of the intervention will be deemed ‘completed’ once the medicines management plan has been agreed upon – either during the medicines optimisation meeting or after the fact if the prescriber was unable to attend. The pharmacist will not be following up on responses to the recommendations as part of the intervention. The final decision for changes in medicines therapy will rest with the participant and prescriber. Participants will also be able to invite whanau (family) and/or support people to be present at these sessions. The pharmacist delivering the intervention (also the lead investigator of this research proposal) is a Maori pharmacist (Ngaruahine) with 15+ years experiencing in medicines optimisation, the majority focusing on older adult medicine, working in both secondary and primary care (mainly Residential Aged care and Retirement Village) settings. She has held governance positions in Maori health organisations, including a member of the Executive Committee of Nga Kaitiaki o Te Puna Rongoa Maori o Aotearoa (The Maori Pharmacists’ Association) for over 8 years including 3 years as President. This work is being undertaken as part of her PhD work, funded by the Health Research Council of NZ under a Clinical Research Training Fellowship. She is a Named Investigator on The National Science Challenge – Ageing Well funded project: Older People in Retirement Village: Unidentified Need and Intervention Research Project. Medicines education Mode of delivery: Face to face with pharmacist Location: Participants choice eg: home, community centre, GP practice Number of times: 1 x one hour Medicines optimisation (optional) Mode of delivery: pharmacist + prescriber Location: GP practice Number of times: 1 x 15-30min (2-3 weeks after medicines education session)