None listed
Conditions
Brief summary
For many people who live with dementia, managing their daily medicines is a complex and difficult task. Whilst medicines are used to improve health, their incorrect use may cause unintended consequences that range from minor symptoms to serious events that require hospitalisation. The role that community pharmacists have in optimising medicine safety is well-recognised, and several generic programs have been developed for pharmacists to help people living in the community use their medicines more safely and easily. Using one of these programs as a basis, our project will develop an in-pharmacy service to meet the specific needs of people living with dementia. The service is called MedsCheck Plus. This will involve the pharmacist holding structured meetings with a person living with dementia (and their family carers if appropriate), so that any medicine-related issues can be identified and overcome. The project will first develop a model for MedsCheck Plus, then train community pharmacists to do them. Finally, twenty people living with dementia will be provided with MedsCheck Plus, and the experiences of the consumers and pharmacists will be studied.
Interventions
The first step of the intervention is the recruitment of the pharmacists. Industry contacts were utilised to gather expressions of interest. From this pool, the pharmacists were then recruited to participate in the pilot trial.
The second step of the intervention involves the pilot pharmacists completing 3-hour Dementia Friendly Pharmacy Course, followed by a 2-hour case study scenario assessment. The Dementia Friendly Pharmacy course is a readily available resource through Dementia Training Au
The first step of the intervention is the recruitment of the pharmacists. Industry contacts were utilised to gather expressions of interest. From this pool, the pharmacists were then recruited to participate in the pilot trial. The second step of the intervention involves the pilot pharmacists completing 3-hour Dementia Friendly Pharmacy Course, followed by a 2-hour case study scenario assessment. The Dementia Friendly Pharmacy course is a readily available resource through Dementia Training Australia and is available at https://dta.com.au/online-courses/dementia-friendly-pharmacy/. The MedsCheck Plus training component will involve an interactive learning management system which include short video scenarios (approx. 2 videos of 10 minutes each), videos (ie Dementia support services and pharmacy patient-centred care) along with learning content on ‘What is dementia’, ‘Types of dementia’, ‘Dementia in Australia’, ‘Identifying signs of dementia’, ‘What is patient-centred care’, ‘Applying a patient-centred approach to dementia care’, ‘Interpret the individual needs of the patient’, ‘MedsCheck Plus patient journey’, ‘Interacting appropriately with a PLWD’, ‘Role of caregiver in dementia care’, ‘Knowledge of support services’, ‘Identifying available services for dementia assessment’, ‘Arranging follow-ups’ and ‘Developing further knowledge in the area of dementia’. A combination of the 2 case study scenarios, learning content, interaction components (i.e. match the words, multiple choice) will make up the 2 hours of learning. Pharmacists will be given one month to complete the provided training material This will ensure that only pharmacists who have completed the required training will be eligible to participate in this study. Training and assessment records will be recorded in Pharmaceutical Society of Australia’s (PSA) Learning Management System (LMS). Pharmacists are also encouraged to record completion of training in their personal training record. The third step of the intervention will involve the trained pharmacist providing the initial face-to-face MedsCheck Plus to the participant. The steps in the patient journey are as follows: • Identifying the need for MedsCheck Plus by initiating a MedsCheck service • Determining eligibility and obtaining consent for a MedsCheck Plus • Reconciliation of patient medication including all prescription, non-prescription and complementary and alternative medication. The family carer may be required to assist with completing this part of the process in collaboration with the patient. The medication profile should be confirmed with the patient’s prescriber/s, and a copy of the completed medication profile will be provided to the patient’s prescriber. The patient and +/- carer should also be provided with the medication profile. • Medication counselling involving a two-way discussion with the patient and +/- carer to ensure that medications are used appropriately and safely. The pharmacist, patient and +/- carer will also agree to any follow up actions and who is responsible. This should be documented in action plan, with dates agreed upon for a follow-up discussion to review the patient’s progress. The patient, caregiver (if present), prescribers and, if relevant, support services, health and/or community care professionals will be provided with copies of the documentation. For the delivery of the intervention, the medication reconciliation and medication counselling process will occur within the initial session. It is anticipated that the length of this session will be 30-60 minutes in length. From this, an additional follow up session will be arranged based on the discretion of the pharmacist depending on the need (recommended at least 4 weeks following). This includes a review of strategies recommended including Webster Packs, complex medication regimes and starting a new dementia medication. The final step of the intervention will involve the pharmacist providing a follow-up MedsCheck Plus consultation. At this time, the pharmacist will monitor the progress of actions identified and agreed upon in the action plan. The timeframe for the follow-up consultation will be at the discretion of the reviewing pharmacist, based on their perception of clinical need and individual patient circumstances. Given the targeted nature of follow-up consultations, it is expected that the normal duration of the consultation would be considerably less than the initial MedsCheck Plus, depending on the complexity and number of issues being followed up. The adherence to the intervention will be qualitatively assessed during the focus group discussions with the participating pharmacists at the conclusion of the study.
Sponsors
University of New South Wales (UNSW)
Study design
Allocation
Non-randomised trial
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Consumers with mild cognitive impairment, diagnosed or suspected dementia and home dwelling in the Perth metropolitan area. The inclusion criteria is also extended to the family carer if appropriate. Pharmacists are to be community pharmacists with access to current Medscheck services in the Perth metropolitan area. The pharmacists will be currently registered to practise with the Australian Health Practitioner Regulation Agency.
Exclusion criteria
Pharmacists working only from aged care or hospitals are excluded from the study. Pharmacists outside of the Perth Metropolitan area or interstate will not be eligible for the study. Consumers no longer able to provide consent due to their cognitive impairment. Consumers currently residing in an aged care facility will be excluded from the study. Consumers residing outside of the Perth Metropolitan area or interstate will not be eligible for the study.
Outcome results
None listed