1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of...
-
Upload
shannon-hudson -
Category
Documents
-
view
213 -
download
0
Transcript of 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of...
![Page 1: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/1.jpg)
1
"Pharmaceutical care in the elderly - the UK experience"
Professor Ian Chi Kei WongDepartment of Health Public Health Career Scientist
The School of PharmacyUniversity of London
![Page 2: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/2.jpg)
2
United Kingdom
• Population– England = 49.1 million– Wales 2.9 million– Northern Ireland = 1.7 million– Scotland = 5.1 million
![Page 3: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/3.jpg)
3
• National Health Service is a state-funded healthcare delivery model.
• Traditionally prescribing and dispensing are separate:– Medical practitioners are prescribers – Pharmacists are medication providers
![Page 4: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/4.jpg)
4
Medical and Pharmaceutical Services
• Primary care medical service provided by General Practice – Also employ other health professionals such
practice nurses and practice pharmacists
• Primary care pharmaceutical services are provided by community (retail) pharmacies
![Page 5: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/5.jpg)
5
Community pharmacy• Community pharmacies
are not employees of NHS• Contractors • On average each
pharmacy provide 100 hours per week service to the NHS
• 80% of income is from the NHS
• Provide a range of services
![Page 6: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/6.jpg)
6
Traditional Service
• Traditional responsibilities of the pharmacist are:
– to prepare and dispense medication for patients
![Page 7: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/7.jpg)
7
Traditional Service
• Traditional responsibilities of the pharmacist are:
– to prepare and dispense medication for patients
– to provide advice for patients
![Page 8: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/8.jpg)
8
Evolution
• Pharmacy has evolved
• The role of the pharmacist has adapted from product-oriented custodian to service-oriented technologist.
![Page 9: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/9.jpg)
9
New services
• New services are available such as– Smoking cessation programme– Supervised administration of methadone – Minor ailments scheme– Contraception including emergency hormonal
contraceptive services– Anticoagulant Monitoring– Medicines Use Review
Pharmacist
![Page 10: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/10.jpg)
10
Pharmaceutical Care
• Pharmaceutical care has been defined as:
"The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life." (Hepler & Strand 1990 and adopted by UKCPA)
![Page 11: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/11.jpg)
11
Medicines Management
• Medicines management encompasses a range of activities intended to improve the way that medicines are used, both by patients and by the NHS.
• Medicines management services are processes based on patient need that are used to design, implement, deliver and monitor patient-focused care.
![Page 12: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/12.jpg)
12
Medicines Management
• For the benefit of this talk
• Pharmaceutical care model in the US = Medicines management model in the UK
![Page 13: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/13.jpg)
13
Results of four major RCTs in Elderly
• Clinical medication review trial (Zermansky et al 2001)
• Medication review trial (Krska et al 2001)
• HOMER medication review trial (Holland et al 2005)
• RESPECT Pharmaceutical Care trial (Wong et al unpublished)
![Page 14: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/14.jpg)
14
Basic details of the studiesZermansky et al 2001
(1131 pts)
One practice pharmacist see patients mainly at practice
Age ≥ 65
≥ 1 repeat
Krska et al 2001
(332 pts)
Clinically-trained Pharmacist see patients at home
Age ≥ 65
≥ 4 repeat +
≥ 2 chronic illness
Holland et al 2005
(872 pts)
Pharmacists with PG training see patients at home
Age ≥ 80, discharge after emergency admission
Wong et al unpublished
(760 pts)
Pt’s usual community pharmacist see patients in community pharmacies
Age ≥ 75
≥ 5 repeat
![Page 15: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/15.jpg)
15
Zermansky et al 2001
• Leeds in West Yorkshire England
![Page 16: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/16.jpg)
16
![Page 17: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/17.jpg)
17
Zermansky et al 2001
• Leeds in West Yorkshire England• 581 in intervention cases and 550 controls • Practice pharmacist see patients at practice• Age ≥ 65 and ≥ 1 repeat• Duration of study = 1 year
![Page 18: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/18.jpg)
18
Clinical medication review (CMR)
• Pharmacist reviewed the patient, the illness, and the drug treatment.
• Evaluated– appropriateness and efficacy of treatments – progress of the conditions– compliance – actual and potential adverse effects
interactions
• The outcome of the review was a decision about the continuation (or otherwise) of the treatment.
![Page 19: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/19.jpg)
19
![Page 20: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/20.jpg)
20
Results
• Pharmacist took ~ 20 minutes each review
• Intervention group more likely to have changes (P = 0.02)
• Mean number of changes per patient
• Interventions = 2.2
• Control = 1.9
![Page 21: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/21.jpg)
21
% of Patients with “Changes”
Type Intervention Control
New Drug 46% 49%
Drug Stopped 41% 33%
Switched drug 20% 17%
Dose changed 17% 11%
Changed to generic 11% 7%
Formulation changed 3% 2%
Frequency changed 1% 0%
Any of the above 75% 72%
![Page 22: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/22.jpg)
22
Changes in Treatment Between the Start and Finish of Study
Intervention Control P value
Mean No. of repeat medicines
4.8 5.0
Increased
by 0.2
4.6 5.0
Increased
by 0.4
0.01
Mean cost over 28 day (£)
29.3 31.1
Increased
by 1.80
28.3 34.9
Increased
by 6.52
0.001
![Page 23: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/23.jpg)
23
No changes in
• Number of GP consultations
• Number of out-patient appointment
• Number of hospital admission
![Page 24: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/24.jpg)
24
Conclusions
• A clinical pharmacist can conduct effective consultations with elderly patients in general practice to review their drugs.
• Such review results in significant changes in patients' drugs and saves more than the cost of the intervention without affecting the workload of general practitioners.
![Page 25: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/25.jpg)
25
Krska et al 2001
• Grampian region of Scotland
![Page 26: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/26.jpg)
26
Grampianregion
![Page 27: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/27.jpg)
27
Krska et al 2001
• Grampian region of Scotland
• 332 patients
• Clinically-trained pharmacist saw patients at home
• Age ≥ 65
• ≥ 4 repeat
• ≥ 2 chronic illness
![Page 28: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/28.jpg)
28
Methods• Pharmacists reviewed 332 patients and
identified the “Pharmaceutical Care Issues”
• Information obtained from the practice computer, medical records & interviews.
• In 168 patients, a pharmaceutical care plan was then drawn up and implemented.
• The 164 control patients continued to receive normal care.
• All outcome measures were assessed at baseline and after 3 months.
![Page 29: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/29.jpg)
29
Pharmaceutical Care Issues Resolutions
Issues Intervention % Resolved
Control % Resolved
P value
Potential/suspected ADR
84.3% 57.8% <0.0001
Monitoring issues 94.6 % 78.4 <0.0001
Potential ineffective therapy
57.1% 24.3 <0.0001
Education required 80.7% 18.4 <0.0001
Inappropriate dosage regime
78.3% 17.9 <0.0001
Page 1 of 3
![Page 30: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/30.jpg)
30
Pharmaceutical Care Issues Resolutions (cont/d.)
Issues Intervention %
Resolved
Control %
Resolved
P value
Potential / actual compliance
68.9 30.4 <0.0001
Untreated indication
66.7 27.5 <0.0001
Drug with no indication
54.2 18.8 <0.0001
Repeat prescription no longer required
96.4 5.9 <0.0001
Inappropriate duration of therapy
72.1 29.1 <0.0001
Page 2 of 3
![Page 31: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/31.jpg)
31
Pharmaceutical Care Issues Resolutions (cont/d.)
Issues Intervention %Resolved
Control % Resolved
P value
Discrepancy between doses prescribed and used
96.4 3 <0.0001
Potential drug-disease interaction
7.2 47.1 0.1302
Others 82.3 59.2 <0.05
TOTAL 78.8 39.3
Page 3 of 3
![Page 32: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/32.jpg)
32
Other outcomes
• No change in medicines cost
• No change in health–related quality of life
• No change in hospital clinic attendance
• Slightly fewer hospital admissions but number was too small to be tested statistically.
![Page 33: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/33.jpg)
33
Conclusion
• Pharmacist-led medication review has the capacity to identify and resolve pharmaceutical care issues and may have some impact on the use of other health services.
![Page 34: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/34.jpg)
34
Holland et al 2005
• Norfolk and Suffolk in England
![Page 35: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/35.jpg)
35
Norfolk and Suffolk
![Page 36: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/36.jpg)
36
Holland et al 2005
• Norfolk and Suffolk in England
• Home based medication review
• 872 patients
• Pharmacists with post-graduate qualification and training
• Saw patients at home
• Age ≥ 80, discharged after emergency admission
![Page 37: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/37.jpg)
37
Methods• Patient's discharge letter was sent to
review pharmacists• Pharmacists arranged home visits• Assessed ability to self medicate &
adherence • Educated the patient and carer • Removed out-of-date drugs• Reported possible ADRs or interactions to
the General Practitioner and the need for a compliance aid to the local pharmacist.
![Page 38: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/38.jpg)
38
Methods
• One follow up visit occurred at six to eight weeks after recruitment to reinforce the original advice.
![Page 39: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/39.jpg)
39
![Page 40: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/40.jpg)
40
Results
• 178 emergency readmissions occurred in the control group
• 234 in the intervention group
• The Poisson model indicated a 30% greater rate of readmission in the intervention group
• Rate ratio = 1.30,
(95% CI 1.07 to 1.58, P = 0.009).
![Page 41: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/41.jpg)
41
No Intervention Control
0 235 281
1 113 99
2 34 26
3 or more 15 8
TOTAL 234 178
Number of Emergency Hospital Re-admissions
![Page 42: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/42.jpg)
42
Survival Analysis over 6 months
P = 0.14
![Page 43: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/43.jpg)
43
Quality of Life
• Utility scores EQ-5D decreased in both groups, but the changes were not significantly different between the groups
• Scores on the visual analogue health scale also fell; the difference of 4.1 (95% CI 0.15 to 8.09) units in favour of the control group (P = 0.042).
![Page 44: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/44.jpg)
44
Other outcomes
• No change in GP clinic attendance
• No change in number of prescription items
![Page 45: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/45.jpg)
45
Conclusion• Home based medication review for older
people recently discharged from hospital increased hospital admissions and worsened patients' quality of life.
• Patients may have adhered better to their drugs, with a resultant increase in adverse effects.
• Alternatively, intervention may have provoked better understanding and help seeking behaviour.
![Page 46: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/46.jpg)
46
Wong et al
• East Yorkshire
![Page 47: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/47.jpg)
47
East Yorkshire
![Page 48: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/48.jpg)
48
Wong et al
• East Yorkshire
• 760 patients
• Patients' usual community pharmacist see patients in community pharmacies
• Age ≥ 75
• ≥ 5 repeat
![Page 49: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/49.jpg)
49
Designs
• Randomised multiple interrupted time series design in which five Primary Care Trusts implemented Pharmaceutical Care at quarterly intervals and in random order.
• We followed patients, who also acted as their own controls, for 36 months between recruitment and final visit, including their 12 months in Pharmaceutical Care.
![Page 50: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/50.jpg)
50
Randomised multiple interrupted time series design
Qtr1
Qtr2
Qtr3
Qtr4
Qtr5
Qtr6
Qtr7
Qtr8
Qtr9
Qtr10
Qtr11
Recruit
TrainA
PC PC PC PC Revisit
Recruit
Control
TrainB
PC PC PC PC Revisit
Recruit
Control
Control
TrainC
PC PC PC PC Revisit
Recruit
Control
Control
Control
TrainD
PC PC PC PC Revisit
Recruit
Control
Control
Control
Control
TrainE
PC PC PC PC Revisit
![Page 51: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/51.jpg)
51
Pharmaceutical Care
• Both pharmacists and GPs attended training before starting the intervention.
• Pharmacists interviewed patients at the community pharmacy and developed a Pharmaceutical Care Plan (PCP).
• Shared the PCP with the patient’s GP.
• Undertook monthly medication reviews for one year.
![Page 52: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/52.jpg)
52
UK Medication Appropriateness Index (UK-MAI).
• Primary outcome was UK-MAI.
• Anglicised this from the US version.
• The resulting score depends on the number of drugs being prescribed and the appropriateness of each.
• As a drug can score between 0 (completely appropriate) and 20 (completely inappropriate), the lower the score the better.
![Page 53: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/53.jpg)
53
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36
Time since recruitment start (Months)
Ave
rag
e M
AI
sco
re
East HullEast RidingWest HullYork and SelbyYorkshire Wolds and Coast
Mean UK-MAI scores
![Page 54: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/54.jpg)
54
Other outcomes
• Pharmaceutical Care has no significant effects on:– Number hospital admission– Number GP clinic consultation– Mortality rate– QoL SF-36
![Page 55: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/55.jpg)
55
RESPECT Conclusion
• We judge that this lack of evidence stems from our experience that Pharmaceutical Care is difficult to implement in full in a community setting.
![Page 56: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/56.jpg)
56
Summary of all 4 studies
• Pharmacists are able to identify pharmaceutical care issues and initiate changes
• However, traditional research instruments are unable to detect positive changes in clinical outcomes
![Page 57: 1 "Pharmaceutical care in the elderly - the UK experience" Professor Ian Chi Kei Wong Department of Health Public Health Career Scientist The School of.](https://reader034.fdocuments.us/reader034/viewer/2022051620/56649e545503460f94b4b9bc/html5/thumbnails/57.jpg)
57
To debate
• Lack of transferability?
• Lack of effects?
• Lack of sensitivity?
• Are we measuring the right things?
• Anything else?????