Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: Cluster randomised controlled trial

Holland, Richard, Bond, Christine, Alldred, David, Arthur, Antony, Barton, Garry, Birt, Linda, Blacklock, Jeanette, Blyth, Annie, Cheilari, Stamatina, Daffu-O’Reilly, Amrit, Dalgarno, Lindsay, Desborough, James ORCID: https://orcid.org/0000-0001-5807-1731, Ford, Joanna C., Grant, Kelly, Harry, Bronwen, Hill, Helen J., Hughes, Carmel, Inch, Jacqueline, Maskrey, Vivienne, Myint, Phyo, Norris, Nigel, Poland, Fiona ORCID: https://orcid.org/0000-0003-0003-6911, Shepstone, Lee, Spargo, Maureen, Turner, David ORCID: https://orcid.org/0000-0002-1689-4147, Watts, Laura, Zermansky, Arnold and Wright, David (2023) Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: Cluster randomised controlled trial. BMJ-British Medical Journal, 380. ISSN 1759-2151

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Abstract

OBJECTIVE: To estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes. DESIGN: Cluster randomised controlled trial, with clusters based on triads of a pharmacist independent prescriber, a general practice, and one to three associated care homes. SETTING: Care homes across England, Scotland, and Northern Ireland, their associated general practices, and pharmacy independent prescribers, formed into triads. PARTICIPANTS: 49 triads and 882 residents were randomised. Participants were care home residents, aged ≥65 years, taking at least one prescribed drug, recruited to 20 residents/triad. INTERVENTION: Each pharmacy independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits over six months. Pharmacy independent prescribers developed a pharmaceutical care plan for each resident, did medicines reviews/reconciliation, trained staff, and supported with medicines related procedures, deprescribing, and authorisation of prescriptions. Participants in the control group received usual care. MAIN OUTCOMES MEASURES: The primary outcome was fall rate/person at six months analysed by intention to treat, adjusted for prognostic variables. Secondary outcomes included quality of life (EQ-5D by proxy), Barthel score, Drug Burden Index, hospital admissions, and mortality. Assuming a 21% reduction in falls, 880 residents were needed, allowing for 20% attrition. RESULTS: The average age of participants at study entry was 85 years; 70% were female. 697 falls (1.55 per resident) were recorded in the intervention group and 538 falls (1.26 per resident) in the control group at six months. The fall rate risk ratio for the intervention group compared with the control group was not significant (0.91, 95% confidence interval 0.66 to 1.26) after adjustment for all model covariates. Secondary outcomes were not significantly different between groups, with exception of the Drug Burden Index, which significantly favoured the intervention. A third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. No adverse events or safety concerns were identified. CONCLUSIONS: Change in the primary outcome of falls was not significant. Limiting follow-up to six months combined with a small proportion of interventions predicted to affect falls may explain this. A significant reduction in the Drug Burden Index was realised and would be predicted to yield future clinical benefits for patients. This large trial of an intensive weekly pharmacist intervention with care home residents was also found to be safe and well received. TRIAL REGISTRATION: ISRCTN 17847169.

Item Type: Article
Additional Information: Funding Information: This work was funded by National Institutes of Health Research (NIHR) through their Programme Grant for Applied Research (PGfAR) stream (RP-PG-0613-20007). The funder had no role in design, data collection, data analysis, data interpretation, or writing of this paper.
Uncontrolled Keywords: medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Social Sciences > School of Economics
Faculty of Science > School of Pharmacy
Faculty of Social Sciences > School of Education and Lifelong Learning
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Faculty of Medicine and Health Sciences > Research Groups > Health Economics
Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research
Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Science > Research Groups > Innovations in Pharmacy Education
Faculty of Science > Research Groups > Patient Care
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 14 Feb 2023 11:30
Last Modified: 14 Jul 2024 04:32
URI: https://ueaeprints.uea.ac.uk/id/eprint/91127
DOI: 10.1136/bmj-2022-071883

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