Addressing potentially inappropriate prescribing in care homes: regional evaluation of a pharmacist-led model in Northern Ireland

Introduction: Potentially inappropriate prescribing (PIP) increases the risk for medication-related harm amongst older adults, with those in long-term care at particular risk. Aim: This study sought to evaluate a medicines optimisation pharmacist case management model for older adults in care homes in Northern Ireland (NI). Method: Secondary analysis of prospective data collected during the case management model delivered to older adults (≥ 65 years) across 32 care homes in NI (N = 1,095). Medication Appropriateness Index (MAI) scores were compared at baseline and post-intervention. Variability in MAI per medication score change (ΔMAI) was examined using multiple linear regression. Multiple logistic and Poisson regressions examined potential associations between ΔMAI and secondary outcomes, including unplanned hospital admissions (all-cause); general practitioner (GP) call-outs; out-of-hours (OOH) GP call-outs; and emergency department (ED) visits. Results: PIP was highly prevalent at baseline (83.5%; n = 914). A significant reduction in MAI (per medication) score was observed from pre to post-intervention; 82% (n = 898) of participants experienced some MAI score improvement. Overall, 3,044 clinical interventions were delivered; 2,062 medications were stopped, 141 medications were started, and 438 dosages were changed. Several unexpected significant associations were observed between ΔMAI and GP call-outs during follow-up; sensitivity analyses suggested these findings were likely due to confounding. No association was observed between ΔMAI (per medication) and likelihood for unplanned hospital admission. Conclusion: PIP is highly prevalent in NI care homes and was significantly reduced by a medicine optimisation pharmacist case management model. Clinical pharmacist input in long-term care is warranted to lessen medication-related harm for older adults.