Special Issue "Optimising Medicines in Care Homes"

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (30 April 2020).

Special Issue Editors

Dr. Wasim Baqir

Guest Editor
NHS England
Interests: prescribing and deprescribing in frailty and older people, living in care homes and their own homes; integrating services across the health and care system; quality improvement and using QI to make care better and safer
Dr. Graham Stretch

Guest Editor
Argyle Health Group & Ealing GP Federation, London W13 8ER, UK
Interests: prescribing and medicines optimisation in elderly care; medicines use in care homes; end-of-life care, dementia and anticholinergic burden in the elderly; pharmacy as part of integrated primary care teams; skill mix in general practice; education and development of pharmacy professionals

Special Issue Information

Dear Colleagues,

The scope of this Special Edition is to share learning on how Pharmacy teams are improving medicines optimisation in care homes.  A number of reports (e.g. CHUMS) have highlighted the suboptimal prescribing, dispensing and administration of medicines in care homes.  In the UK, we have seen many advances in medicines optimisation in care homes. Following on from the Care Home Vanguards, NHS England launched a medicines optimisation in care homes programme to share and spread learning across England. In Scotland the Realistic Medicines agenda and Polypharmacy Guidance is supporting medicines optimisation in care homes. Wales and Northern Ireland too, have initiatives supporting care homes and their residents.  With so much going on in this field, now is the time start sharing innovative and best practice.

We encourage teams working in care home settings to present your research, reviews and quality improvement work.  We are particularly interested in work related to quality improvement methods to develop clinical services, outcomes data, integrated working, shared decision making with residents, the role of the multidisciplinary team, skill mix (including the role of the pharmacy technician) and deprescribing. We hope that your work will help support clinical teams to develop their services.

Dr. Wasim Baqir
Dr. Graham Stretch
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Medicines Optimisation
  • Deprescribing
  • Shared Decision Making
  • Care Homes
  • Integration
  • Pharmacy Skill Mix in Care Homes

Published Papers (3 papers)

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Research

Open AccessArticle
Deprescribing of Medicines in Care Homes—A Five-Year Evaluation of Primary Care Pharmacist Practices
Pharmacy 2019, 7(3), 105; https://doi.org/10.3390/pharmacy7030105 - 03 Aug 2019
Abstract
(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. [...] Read more.
(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines. Full article
(This article belongs to the Special Issue Optimising Medicines in Care Homes)
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Open AccessArticle
Pharmacy Technician Review of Oral Nutritional Supplements (ONS) within Care Homes
Pharmacy 2019, 7(1), 28; https://doi.org/10.3390/pharmacy7010028 - 06 Mar 2019
Abstract
Up to 42% of patients admitted to care homes are at risk of malnutrition. Oral nutritional supplements (ONS) can be prescribed to increase nutritional intake when diet alone is insufficient to meet daily nutritional requirements. Where ONS are inappropriately initiated or continued beyond [...] Read more.
Up to 42% of patients admitted to care homes are at risk of malnutrition. Oral nutritional supplements (ONS) can be prescribed to increase nutritional intake when diet alone is insufficient to meet daily nutritional requirements. Where ONS are inappropriately initiated or continued beyond treatment goals this can contribute to significant waste and unnecessary costs. This study reviewed whether pharmacy technicians working in care home settings can support the cost-effective use of ONS. A quality improvement project using Plan-Do-Study-Act (PDSA) methodology was undertaken by pharmacy technicians working in care homes to review the prescribing and monitoring of ONS. A sample of 330 residents were reviewed across 5 care homes. 45 residents were prescribed ONS, 16 of whom were unknown to dietitians. In collaboration with the dietetic service an oral nutritional support flow chart was developed and tested. Thirteen of the 16 residents unknown to the dietetic team did not require ONS and could be considered for alternative dietary options. Through collaborative working with dietetic services, pharmacy technicians can support effective use and review of ONS for care home residents, reduce unnecessary prescribing, and ensure appropriate referral to dietitians where indicated. Full article
(This article belongs to the Special Issue Optimising Medicines in Care Homes)
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Open AccessFeature PaperArticle
Validation of a Drug-Related Problem Classification System for the Intermediate and Long-Term Care Setting in Singapore
Pharmacy 2018, 6(4), 109; https://doi.org/10.3390/pharmacy6040109 - 03 Oct 2018
Abstract
Background: This study aims to evaluate the inter-rater reliability and perceived usability of a newly developed drug-related problem (DRP) classification system for use by pharmacists in the intermediate and long-term care (ILTC) setting in Singapore. Methods: This was a cross-sectional survey study [...] Read more.
Background: This study aims to evaluate the inter-rater reliability and perceived usability of a newly developed drug-related problem (DRP) classification system for use by pharmacists in the intermediate and long-term care (ILTC) setting in Singapore. Methods: This was a cross-sectional survey study involving the use of a self-administered questionnaire. All 55 pharmacists affiliated to the Pharmaceutical Society of Singapore (PSS) ILTC Pharmacists Workgroup who were above 21 years old and not authors of the classification system were invited to participate. The inter-rater reliability of participants’ classification of 46 mock DRP cases using the new DRP classification system was determined using Fleiss’s kappa (κ). Participants’ perceived usability of the classification system was evaluated using six items with five-point Likert scales (1—“strongly disagree”, 5—“strongly agree”). Results: Thirty-three pharmacists responded to the survey. Overall inter-rater reliability was found to be substantial (κ = 0.614; 95% CI: 0.611–0.617). All usability items received positive ratings (“strongly agree” or “agree”) from at least 69% of participants. Conclusion: The new DRP classification system has substantial external validity and appears to be suitable for use by pharmacists to document and report DRPs in the ILTC setting in Singapore and facilitate evaluation of the impact of pharmaceutical care in the ILTC setting. Full article
(This article belongs to the Special Issue Optimising Medicines in Care Homes)
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