- Home Care (HC) services—where the person receives care in their home dwelling; or
- Residential Aged Care (RAC) services—where the individual is provided care within a Residential Aged Care Home (RACH).
2. Materials and Methods
2.1. Inclusion Criteria
2.2. Data Extraction
2.3. Synthesis of Data
3.1. Literature Search, Screening, and Selection of Papers
3.2. Characteristics of the Selected Papers
3.3. Data Extraction
- Type of care delivery;
- Work context of the pharmacist; and
- Supportive professional and personal characteristics as soft skills.
3.3.1. Theme One: Type of Care Delivery
3.3.2. Theme Two: Work Setting of the Pharmacist
- Real time liaison with GPs as part of case conferencing ;
- Clarification of information relating to the prescription, including changes to the packing of dose administration aids ; and
- Anticipating which subcutaneous medicines to stock that are useful in managing symptoms expected in the last days of life .
3.3.3. Theme Three: Supportive Professional and Personal Characteristics as Soft Skills
- Writing medication review recommendations as a “medication management plan” to make it more acceptable and relevant for GPs to provide feedback ;
- Supporting and maintaining trusting relationships with a multidisciplinary team of practitioners ;
- Demonstrating a positive and helpful attitude to medication prescribers and other clinicians ;
- Communicating with medication prescribers in a clear and honest manner ; and
- Following-up with medication prescribers if no response to medication reviews outcome reports are received .
Implications for Policy and Practice in Aged Care
Conflicts of Interest
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|1.||Population of interest||Pharmacists practising predominantly in dispensing or non-dispensing role.|
|2.||Settings of interest||Community setting comprising dispensing pharmacy, general medical practice, residential aged care facility, Aboriginal health services, and peoples’ own home.|
|3.||Phenomenon of interest||Roles and responsibilities of community pharmacists supporting older people aged 65 years and over and their carer living in the community with palliative care needs.|
|4.||Types of studies||Quantitative or qualitative studies, including peer-reviewed journal articles and grey literature documents. Studies were selected if they reported one or more of the inclusion criteria (i.e., 1–3) outlined above.|
|Level I||Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis|
|Level II||Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis|
|Level III||Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis|
|Level IV||Respected authorities’ opinions, nationally recognized expert committee or consensus panel reports based on scientific evidence|
|Level V||Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence|
|Author, Year||Title||Study Design||Setting||Country||Level of Evidence||Count of Data Elements||Summary Description|
|Burns, 2014 ||New horizons in care home medicine||Systematic review of experimental, quasi experimental, and non-experimental studies||Residential Aged Care Home (RACH)||UK||Level III||8||Reviews role of RACH staff including pharmacists in integrated models of care supporting better outcomes for older people.|
|Crecelius, 2006 ||Pain Control: No Time to Rest on Our Laurels||Expert opinion||RACH||USA||Level V||7||Provides expert commentary on pain management for older people living in RACH environments|
|Disalvo, 2019 ||Pharmacists’ perspectives on medication reviews for long-term care residents with advanced dementia: a qualitative study||Qualitative study using semi-structured interview||RACH||Australia||Level III||29||Explores pharmacist perspectives of the Australian Government funded residential medication management review and its role improving the quality and safety of prescribing for people with advanced dementia.|
|Elliott, 2016 ||Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service: A Retrospective Observational Study||Retrospective records audit and telephone interview||Home Care||Australia||Level III||12||Explores the characteristics of older people referred for medicines management support, type of support provided, medication errors, and Adverse Drug Reactions.|
|Hays, 1984 ||Home Care of the Frail Elderly And the Terminally Ill||Expert opinion||Home Care||UK||Level V||5||Discusses general principles of managing elderly and terminally ill patients in a home environment.|
|Kuruvilla, 2018 ||Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives||Qualitative study using focus group||Both RACH and Home Care||Australia||Level III||20||Explores the gaps in the current model of community palliative care services on medication management and the role of a pharmacist in addressing these.|
|LaMantia, 2010 ||Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review||Systematic review of experimental, quasi experimental, and non-experimental studies||RACH||USA||Level III||7||Identifies and evaluates interventions to improve the communication of accurate and appropriate medication lists and advance directives for older people who transition between a RACH and a hospital.|
|Martin, 2011 ||There’s No Place Like Home: A Pharmacist Fills the Need||Case report||Home Care||USA||Level V||14||Describes the practice of a pharmacist working with older people receiving home care.|
|Meade, 2006 ||Innovative Services for Assisted Living, Hospice, and the Community||Case report||Both RACH and Home Care||USA||Level V||29||Describes the practice of a pharmacist who provides medication management services to older people living in a RACH or receiving home care.|
|Noyce, 1990 ||Intramural and extramural health care in the United Kingdom||Expert opinion||Both RACH and Home Care||UK||Level V||8||Describes the factors that determine whether health care in the United Kingdom is provided in hospital, at home, or through intermediate or shared care arrangements.|
|Prukowski, 2017 ||The DE-PHARM Project: A Pharmacist-Driven Deprescribing Initiative in a Nursing Facility||Quality improvement intervention study||RACH||USA||Level V||10||Assesses the acceptance of recommendations from the pharmacist to the primary care team regarding the discontinuation of medications used for the management of comorbid diagnoses.|
|Tait, 2017 ||Improving community access to terminal phase medicines through the implementation of a “Core Medicines List” in South Australian community pharmacies||Qualitative study using repeat survey||Both RACH and Home Care||Australia||Level III||14||Identifies changes in community access to medicines for managing symptoms in the terminal phase following the development of a “Core Medicines List”.|
|Tamura, 2012 ||Outcomes of Polypharmacy in Nursing Home Residents||Comprehensive literature review||RACH||USA||Level V||13||Reviews the outcomes of polypharmacy in RACHs.|
|Tija, 2013 ||Studies to Reduce Unnecessary Medication Use in Frail Older Adults: A Systematic Review||Systematic review of experimental, quasi experimental, and non-experimental studies||Both RACH and Home Care||USA||Level III||20||Identifies interventions that reduce the use of unnecessary medications in frail older adults and patients approaching end of life.|
|Theme (n = 3)||% (n) of Data Elements||Definition||Domain (n = 8)||Meaning Unit (n = 37)|
|Type of care delivery||72% (n = 140)||Pharmacists support the medicines management of people living with palliative care needs directly with the patients themselves and indirectly by improving the performance of the organisation.||Clinical review||Reconciling medications; Deprescribing; Guiding the adjustment of medication doses; Identifying medication related problems; Assessing appropriateness and safety of prescribed medications;|
|Supply of medicines||Stocking subcutaneous injections; Dispensing; Returning of unwanted medicines; Delivering Medicines to the home; Supplying medicines to a residential aged care home; Offering a dose administration aid service; Providing medicines information; Counselling and educational intervention|
|Clinical governance||Participating on Medicines Advisory Committees in residential aged care home; Educating nursing workforce including carers; Auditing of medications; Developing policies and guidelines|
|Work setting of the pharmacist||20% (n = 40)||Pharmacists collaborate with multidisciplinary workforce to achieve optimal results in patient care.||Community Pharmacy||Clarifying prescriptions with prescribers; Improving access to subcutaneous medicines; Participating in case conferences; Discussing medication review findings|
|Residential Aged Care Homes||Reviewing medicines on admission; Participating in multidisciplinary medication reviews; Participating in case conferences; Understanding patient’s goals of care; Supplying medicines to RACH imprest stock|
|General Medical Practice||Offering a clinical resource; Providing medicines information; Improving efficiency of medication reviews|
|Supportive professional and personal characteristics as soft skills||8% (n = 16)||Pharmacists use soft skills in their role to assist and provide support to patients with their medication management.||Soft skills in supporting person-centred care||Advocating; Following-up|
|Soft skills in dealing with clinician prescribers||Framing of recommendations; Building trusting relationships; Developing creative communication approaches; Demonstrating a positive and helpful attitude; Communicating in a clear and honest manner; Facilitating referrals|
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