The acceptability of a pharmacist-led intervention on polypharmacy in older adults.

Feasibility/acceptability trial. Physical or informational materials that will be used in the intervention: Patient reported outcome measure - Living with Medicine version 3 (LMQ3) questionnaire Practitioner reported questionnaire - Attitudes Towards Collaboration Instruments for General Practitioners (ATCI-GP) questionnaire Each of the procedures, activities, and/or processes used, including any enabling or support activities: 1. Polypharmacy information technology tool The study will utilize the MidCentral District Health Board based computerized polypharmacy information technology tool which searches New Zealand Ministry of Health provided national pharmaceutical claims data, to identify and triage polypharmacy adults aged 65 years and over who were dispensed 11 or more unique long-term medications enrolled at the participating general practice clinic. 2. Presentation to participating general practice team The general practice GPs, Nurse Practitioners and managers will be offered a researcher and clinical pharmacist-led training session to: • Discuss the clinic’s polypharmacy trends. • Provide polypharmacy education and rational medication use guidelines. • Formulate a consensus for a clinic action plan to reduce inappropriate polypharmacy for their patients. 3. Medication Therapy Assessment Intervention patient participants will be provided a 30-minute clinical pharmacist-led Medication Therapy Assessment (MTA) in partnership with their GP/Nurse Practitioner, at their general practice. A MTA is a core medication management service provided by clinically experienced, MTA accredited pharmacists as part of their working roles within multidisciplinary healthcare teams. MTAs are “a systematic, patient-centered clinical assessment of all medicines currently taken by a patient” (1). The clinical pharmacist will meet with the patient to discuss their medications and individual therapy goals. Then, utilizing their knowledge of medications, develop a patient centered medication treatment plan. In this study, the goals of the MTA will be to: - Rationalize and reduce inappropriate polypharmacy. - Identify, resolve and avoid medication related problems. - Improve the effectiveness of the patient’s medication therapy. The protocol to conduct MTAs was based on guidelines from Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model (2) and involves: 1. Meeting with the patient and reviewing their clinical information. 2. Evaluating patient characteristics such as literacy level which may affect their health or medication outcomes. 3. Evaluating whether any patient symptoms could be attributed to the adverse effects or interactions from their medications. 4. Interpreting, assessing and monitoring patient laboratory results. 5. Assessing, detecting, and prioritizing patient medication concerns including inappropriate polypharmacy, inappropriate medications, dosage or regimens, adverse effects, contraindications, or interactions. 6. Working with the patient to develop a mutually agreed plan to resolve identified medication issues. 7. Providing patient medication education and training. 8. Monitoring, follow-up, and evaluating patient medication response. 9. Communicating recommendations to the GP/Nurse Practitioner and other healthcare professionals. Pharmacist recommendations following the MTA will be discussed with the participant’s GP/Nurse Practitioner in person and through electronic task messages within the practice management system. The GP/Nurse Practitioner will be free to accept or decline the pharmacist’s recommendations. After the MTA, 30-minutes will be allocated for patient participants to be interviewed and complete the Living with Medicines Questionnaire version 3 (LMQ3), a 41 item Patient Reported Outcome Measure questionnaire (3) to evaluate their health and medicine use. 4. Follow-up After 8-weeks, patient participants will meet with the researcher again at the clinic for a follow up 30-minute interview and LMQ-3 questionnaire. Changes to LMQ-3 scores will be used to evaluate health/medicine use. 5. Study Conclusion At study conclusion, clinic GPs and Nurse Practitioners will be posted an anonymous 5-minute, 13 item Attitudes Towards Collaboration Instruments for General Practitioners (ATCI-GP) questionnaire (4) to complete which evaluate GP/Nurse Practitioner experience of the pharmacist’s integration and impact on polypharmacy/health outcomes. Completed questionnaires will be returned to the researcher by paid return post. References 1. Pharmaceutical Society of New Zealand. Medicines Therapy Assessment [Internet]. New Zealand: Pharmaceutical Society of New Zealand; 2021. Available from: https://www.psnz.org.nz/college/accreditation/mta 2. American Pharmacists Association and the National Association of Chain Drug Stores Foundation. Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model [Internet]. United States of America: American Pharmacists Association and the National Association of Chain Drug Stores Foundation; 2008. Available from: https://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf 3. Katusiime B, Corlett S, Krska J. Development and Validation of a Revised Instrument to Measure Burden of Long-term Medicines Use: the Living with Medicines Questionnaire version 3. Patient Relat Outcome Meas. 2018; 9: 155-168 4. Van C, Costa D, Mitchell B, Abbott P, Krass I. Development and Validation of a Measure and a Model of General Practitioner Attitudes Toward Collaboration with Pharmacists. Res Social Adm Pharm. 2019; 6(6): 688-699 Who will deliver the intervention and their expertise: Clinical pharmacist with: - Greater than 2 years' experience working in general practice providing patient centered Medication Therapy Assessments. - Postgraduate qualification in clinical pharmacy. The mode of delivery: Face to face provided individually between participant and clinical pharmacist. The number of times the intervention will be delivered and over what period of time: Patient participants will be offered one 30-minute Medication Therapy Assessment session with the clinical pharmacist. Location where the intervention occurs: urban general practice clinic