Pharmaceutical care for elderly patients in community pharmacy : Analysis and evaluation of community pharmacist interventions in the Randomised Evaluation of Shared Prescribing for Elderly People in the Community over Time (RESPECT) Study.

Abstract

The impact of the pharmacist in elderly patient healthcare management is developing. In our study, the interventions made by community pharmacists in the RESPECT study (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) were analysed and evaluated. In our study, the study sample was chosen according to specific criteria. The outcomes of these pharmacist interventions were measured by a clinical panel which scored and categorised each intervention into one of five categories. The study also investigated the percentage of interventions implemented or not implemented by GPs. In our study, initially 398 patients and of these 52 were excluded because their files did not contain the entry criteria information, leaving 346 patients who were identified with a mean (SD) of 8.9 (3.3) pharmaceutical care plans which contained mean (SD) 8.2(7.2) pharmaceutical care issues. Of these 43% were males and 57% were females with a mean (SD) age of 81(3.7) years. There were many missing data about drugs prescribed due to poor documentation by community pharmacists in the RESPECT study particularly at post study period (T5). The mean (SD) for all drugs prescribed was 35.9 (12.38) for each patient and for the whole study period including the post period (T5). In our study a total of 2879 individual pharmaceutical care issues were identified. A clinical panel judged that 43% of the interventions prevented harm, 31% improved the efficacy of management, 3% were detrimental to the patient¿s management plan, 12% only provided information and there was insufficient information to make a decision on the remaining 11%. For the classifications prevented harm to the patient and improve efficacy of management, the panel gave a score of 7 or more to 264 and 103 respectively which were classed as potential prevented hospital admissions. The outcome of 1628 could not be determined from the data and the pharmacist did not intervene on 361 occasions. Of the remaining 890 (30.9%) GPs accepted 715 and did not accept 175. The cost effectiveness of providing pharmaceutical care to older people by community pharmacists could be estimated (£620,000) by calculating reduction in expenditure of hospital admissions. In addition, there would be the possibility of reduced pressure on other NHS resources such as availability of hospital beds. The involvement of a clinical pharmacist in elderly patient health care, within the setting of a community pharmacy, provided positive healthcare outcomes and therefore should be encouraged in line with the new white paper for England "Building on strengths-delivering the future" (2008). The study emphasises the importance of revising the nature and period of postgraduate training for community pharmacists who are going to provide pharmaceutical care for elderly patients. This raises the possibility of specialised competency based postgraduate training for community pharmacists with a special interest in the care of older people (PhwSI). This would enable community pharmacists practising as generalists to become advanced practitioners in the specialist clinical area of older people and ensure a consistent level of service for elderly patients in line with government expectations.