Journal
RESEARCH IN SOCIAL & ADMINISTRATIVE PHARMACY
Volume 17, Issue 4, Pages 715-722Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.sapharm.2020.06.010
Keywords
Deprescribing; Drug burden index; Dementia; Older adults; Patient centred care; Home medicines review; Evaluation; Mixed-methods
Funding
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre (CDPC) [91000]
- NHMRC
- Hammond Care
- Alzheimer's Australia
- Brightwater Care Group
- Helping Hand Aged Care
- University of Sydney, Ageing and Pharmacology Group
- Australian NHMRC
- Australian Research Council Dementia Research Development Fellowship
- Australian NHMRC Dementia Leadership Fellowships
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The study shows that the CCDSS system G-MEDSS is useful in helping ACPs identify and assess anticholinergic and sedative medications in Home Medicines Reviews. However, there are challenges in obtaining treatment goals from HMR recipients. Further refinement of the tools and their use in combination may be needed based on mixed feedback from ACPs.
Background: Use of high-risk medications is common and associated with adverse effects in older adults, including those living with dementia. A Computerised Clinical Decision Support System (CCDSS) called GMEDSS? (Goal-directed Medication Review Electronic Decision Support System) contains tools that identify medications with anticholinergic and sedative effects and align older adult?s health and medication goals of care with medication management strategies. Objectives: To describe the utility of a CCDSS called G-MEDSS in Home Medicines Review (HMR) by an accredited clinical pharmacist (ACP) using a mixed-methods process evaluation method. Methods: A mixed-methods process evaluation was conducted as part of a nation-wide cluster-randomised clinical trial evaluating the effectiveness of implementing G-MEDSS in HMR. Data were collected from ACPs and HMR recipients (the patient) using a feedback survey (ACPs and HMR recipients) and one-on-one telephone interviews (HMR recipients). Quantitative and qualitative data were combined at the start of analysis. Content analysis of the qualitative data was conducted, and emerging categories were linked to quantitative data. Results: Feedback surveys were completed by eight ACPs and 26 HMR recipients; 11 HMR recipients completed one-on-one telephone interviews. Overall, ACPs and HMR recipients who received the intervention reported a positive attitude towards the utility of G-MEDSS in HMR. ACPs reported that G-MEDSS enhanced their ability to make evidence-based recommendations about anticholinergic and sedative medications, and to better align HMR recommendations with HMR recipients? goals of care. However, ACPs described that it was difficult to obtain goals of care from HMR recipients. HMR recipients gave mixed reports about the ACPs consultations: some HMR recipients reported that they were engaged in discussions about their views on medications, whilst other participants reported that discussions about their concerns towards medications and goals was limited. Conclusions: This study suggests that a CCDSS, such as G-MEDSS, demonstrates good utility to assist ACPs to identify and assess anticholinergic and sedative medications. Given the mixed feedback from the ACPs on the different components of the G-MEDSS, further refinement of these tools and their use in combination in practice may be needed.
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