A pharmacist-led intervention for increasing the uptake of Home Medicines Review (HMR) among residents of retirement villages (PHARMER): protocol for a cluster randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The majority of retirement village residents are at risk of medication misadventure. In a recent survey of retirement village residents in Victoria, two-thirds had at least one medication-related risk factor, and hence were eligible to receive a government-subsidised Home Medicines Review (HMR). However, only 6% of eligible residents had received a HMR in the previous 12 months. Reasons for the poor uptake of HMR, and interventions for improving HMR uptake, have been identified and developed with input from stakeholders. The trial will test the effect of <b>P</b>harmacist-conducted <b>H</b>MR to <b>A</b>ddress the <b>R</b>isk of <b>M</b>edication-related <b>E</b>vents in <b>R</b>etirement Villages (PHARMER) in improving the uptake of HMRs among retirement village residents.</p> <p>Methods/Design</p> <p>This is a multicentre prospective cluster randomised controlled trial. Ten retirement villages in Victoria, Australia will be recruited for this trial. Retirement villages will be selected in consultation with the Residents of Retirement Villages Victoria Inc. (RRVV), based on geographical locations (e.g. northeast or southwest), size and other factors. Residents from selected villages will be recruited with the help of RRVV Resident Liaison Officers using a range of strategies. Randomisation will be by geographical location to minimise contamination. Participating villages and residents will be allocated to either Pharmacist Intervention Group (PIG) or Usual Care Group (UCG). Each group will include five retirement villages and will have at least 77 residents in total. The intervention (PHARMER) comprises educating residents regarding HMR, and using a risk assessment checklist by residents to notify their General Practitioners of their medication risk. Uptake of HMR and medication adherence will be assessed in both PIG and UCG at three and six months using telephone interviews and questionnaires.</p> <p>Discussion</p> <p>This study is the first to develop and test an intervention to improve the uptake of HMR among Australian residents in retirement villages, with a view to decreasing medication risk. A multi-faceted interventional approach will be used as suggested by stakeholders. The trial is expected to be complete by late 2011 and results will be available in 2012.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trials Registry (<a href="http://www.anzctr.org.au/ACTRN12611000109909.aspx">ACTRN12611000109909</a>)</p

Investigating the safe use of medicines among older residents of Australian retirement villages and supported residential services

This thesis describes research investigating medication use and pharmacist-led medication reviews among older residents of Australian retirement villages and Supported Residential Services (SRSs). Background: Medication-related problems (MRPs) are common in older Australians and sometimes lead to poor health outcomes and increased healthcare costs. About one in five unplanned hospitalisations in this group are due to MRPs. Home Medicines Review (HMR) is a pharmacist-conducted medication review service funded by the Australian Government for community patients who are at risk of MRPs to reduce medication misadventure and optimise medication use in this group. Older Australians living in retirement villages and SRSs may be at risk of experiencing MRPs and hence may benefit from a HMR, but limited information is available on medication use and the uptake of HMRs in these groups. The aims of this research were to investigate medication use and the uptake of HMRs in these populations and explore strategies to increase HMR uptake and evaluate their effectiveness. Methods: In Phase 1, cross-sectional mail surveys were carried out among a convenience sample of retirement village and SRS residents (n = 2,116 and 77, respectively) to determine their medication use, medication-related risk factors and uptake of HMRs. In Phase 2, in-depth interviews and focus groups were carried out with a purposive sample of stakeholders (n = 32 retirement village residents and 20 health professionals) to explore their views on the HMR service and issues affecting uptake in retirement village residents. In Phase 3, a cluster randomised controlled trial (cRCT) was carried out among a convenience sample of retirement village residents (n = 161 [92 intervention; 69 control]) to assess whether a multi-faceted intervention would increase their uptake of HMRs. All studies were undertaken in Victoria, Australia. Key findings: The surveys found that 1,374/2,116 (65%) retirement village and 56/77 (73%) SRS residents had medication-related risk factor(s), and hence would meet the eligibility criteria for a HMR. However, only 76/1,374 (6%) at-risk retirement village and 3/56 (5%) at-risk SRS residents had received a HMR in the previous 12 months. During the stakeholder interviews and focus groups, reasons for the poor uptake of HMRs and strategies for increasing the uptake in retirement village residents were identified. A strategy recommended by stakeholders for increasing HMR uptake was to use a multi-faceted intervention targeting residents and their health professionals. When the intervention was tested in the cRCT (involving 161 retirement village residents), no significant increase was seen in the uptake of HMRs. Reasons for the ineffectiveness of the intervention have been proposed along with practice implications and future research directions. Conclusions: The research has identified important issues which require the attention of healthcare providers. These include: the majority of retirement village and SRS residents are at risk of experiencing MRPs but the uptake of HMRs in these groups is very low; the poor uptake in retirement village residents is due to a range of patient, health professional and system factors; and there is a need for strategies to increase HMR uptake in retirement village and SRS residents

Investigating the safe use of medicines among older residents of Australian retirement villages and supported residential services

This thesis describes research investigating medication use and pharmacist-led medication reviews among older residents of Australian retirement villages and Supported Residential Services (SRSs). Background: Medication-related problems (MRPs) are common in older Australians and sometimes lead to poor health outcomes and increased healthcare costs. About one in five unplanned hospitalisations in this group are due to MRPs. Home Medicines Review (HMR) is a pharmacist-conducted medication review service funded by the Australian Government for community patients who are at risk of MRPs to reduce medication misadventure and optimise medication use in this group. Older Australians living in retirement villages and SRSs may be at risk of experiencing MRPs and hence may benefit from a HMR, but limited information is available on medication use and the uptake of HMRs in these groups. The aims of this research were to investigate medication use and the uptake of HMRs in these populations and explore strategies to increase HMR uptake and evaluate their effectiveness. Methods: In Phase 1, cross-sectional mail surveys were carried out among a convenience sample of retirement village and SRS residents (n = 2,116 and 77, respectively) to determine their medication use, medication-related risk factors and uptake of HMRs. In Phase 2, in-depth interviews and focus groups were carried out with a purposive sample of stakeholders (n = 32 retirement village residents and 20 health professionals) to explore their views on the HMR service and issues affecting uptake in retirement village residents. In Phase 3, a cluster randomised controlled trial (cRCT) was carried out among a convenience sample of retirement village residents (n = 161 [92 intervention; 69 control]) to assess whether a multi-faceted intervention would increase their uptake of HMRs. All studies were undertaken in Victoria, Australia. Key findings: The surveys found that 1,374/2,116 (65%) retirement village and 56/77 (73%) SRS residents had medication-related risk factor(s), and hence would meet the eligibility criteria for a HMR. However, only 76/1,374 (6%) at-risk retirement village and 3/56 (5%) at-risk SRS residents had received a HMR in the previous 12 months. During the stakeholder interviews and focus groups, reasons for the poor uptake of HMRs and strategies for increasing the uptake in retirement village residents were identified. A strategy recommended by stakeholders for increasing HMR uptake was to use a multi-faceted intervention targeting residents and their health professionals. When the intervention was tested in the cRCT (involving 161 retirement village residents), no significant increase was seen in the uptake of HMRs. Reasons for the ineffectiveness of the intervention have been proposed along with practice implications and future research directions. Conclusions: The research has identified important issues which require the attention of healthcare providers. These include: the majority of retirement village and SRS residents are at risk of experiencing MRPs but the uptake of HMRs in these groups is very low; the poor uptake in retirement village residents is due to a range of patient, health professional and system factors; and there is a need for strategies to increase HMR uptake in retirement village and SRS residents

Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service:A Retrospective Observational Study

BACKGROUND: Increasing numbers of older people are receiving support with medicines management from community nursing services (CNSs) to enable them to live in their own homes. Little is known about these people and the support they receive. OBJECTIVES: To explore the characteristics of older people referred for medicines management support, type of support provided, medication errors and adverse medication events (AMEs). METHODS: A retrospective observational study of a random sample of 100 older people referred to a large non-profit CNS for medicines management support over a 3-month period was conducted. Measures were: demographics, referral source, current medical problems, medicines, medication aids, types of medication authorisations used by nurses, frequency of nurse visits and type of support provided, medication errors, AMEs and interdisciplinary teamwork among community nurses, general practitioners and pharmacists. RESULTS: Older people (median 80 years) were referred for medicines support most often by hospitals (39 %). Other referrals were from families/carers, case-managers, palliative care services and general practitioners. Multiple health conditions (median 5) and medicines (median 10) were common; 66 % used ≥5 medicines; 48 % used ≥1 high-risk medicines—most commonly opiates, anticoagulants and insulin. Medication aids were frequently used, mostly multi-compartment dose administration aids (47 %). Most people received regular community nurse visits (≥4 per week) to administer medicines or monitor medicine-taking. Only 16 % had a medication administration chart; for other clients nurses used medicine lists or letters from doctors for medication authorisation. Medication errors occurred in 41 % of people and 13 % had ≥1 AME requiring medical consultation or hospitalisation; 9/13 (64 %) AMEs were potentially preventable. There was little evidence of interdisciplinary teamwork or medication review. CONCLUSION: CNS clients had multiple risk-factors for medication misadventure. Deficiencies in medicines management were identified, including low use of medication charts and interdisciplinary medication review. Strategies are needed to improve medicines management in the home-care setting. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40801-016-0065-6) contains supplementary material, which is available to authorized users