Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings

Ann Sinéad Doherty; Gary Adamson; John Mallett; Carmel Darcy; Anne Friel; Michael G. Scott; EF Ruth Miller

doi:10.1016/j.sapharm.2022.03.015

Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings

Ann Sinéad Doherty, Gary Adamson, John Mallett, Carmel Darcy, Anne Friel, Michael G. Scott, EF Ruth Miller

Research output: Contribution to journal › Article › peer-review

93 Downloads (Pure)

Abstract

BACKGROUND: Whilst attention has been paid within the literature to examining potentially inappropriate prescribing (PIP) for older adults in a variety of care settings, less is known about the extent within intermediate care. Furthermore, few studies have examined the utility of clinical pharmacist involvement in this care context.

OBJECTIVE(S): Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.

METHODS: Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.

RESULTS: PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.

CONCLUSIONS: Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.

Original language	English
Pages (from-to)	3669-3679
Number of pages	10
Journal	Research in Social and Administrative Pharmacy
Volume	18
Issue number	9
Early online date	11 Apr 2022
DOIs	https://doi.org/10.1016/j.sapharm.2022.03.015
Publication status	Published (in print/issue) - 30 Sept 2022

Bibliographical note

Funding Information:
ASD received funding from Ulster University Vice Chancellor's Research Scholarship. EFRM received funding from the Western Health and Social Care Trust Research Discretionary Fund. The funders had no role in the design of the study, data collection, analysis or interpretation of data, writing of the manuscript nor the decision to submit for publication.

Publisher Copyright:
© 2022 Elsevier Inc.

Copyright © 2022 Elsevier Inc. All rights reserved.

Keywords

Medicines optimisation
Potentially inappropriate prescribing
Pharmacist intervention
Case management
Healthcare utilisation

Access to Document

10.1016/j.sapharm.2022.03.015

1-s2.0-S1551741122000912-mainAuthor Accepted Manuscript, 731 KBLicence: CC BY-NC-ND

Cite this

@article{f065a476446e4c8dbd4e1dee3fa3bd9d,

title = "Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings",

abstract = "BACKGROUND: Whilst attention has been paid within the literature to examining potentially inappropriate prescribing (PIP) for older adults in a variety of care settings, less is known about the extent within intermediate care. Furthermore, few studies have examined the utility of clinical pharmacist involvement in this care context.OBJECTIVE(S): Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.METHODS: Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.RESULTS: PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.CONCLUSIONS: Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.",

keywords = "Medicines optimisation, Potentially inappropriate prescribing, Pharmacist intervention, Case management, Healthcare utilisation",

author = "Doherty, {Ann Sin{\'e}ad} and Gary Adamson and John Mallett and Carmel Darcy and Anne Friel and Scott, {Michael G.} and Miller, {EF Ruth}",

note = "Funding Information: ASD received funding from Ulster University Vice Chancellor's Research Scholarship. EFRM received funding from the Western Health and Social Care Trust Research Discretionary Fund. The funders had no role in the design of the study, data collection, analysis or interpretation of data, writing of the manuscript nor the decision to submit for publication. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc. Copyright {\textcopyright} 2022 Elsevier Inc. All rights reserved.",

year = "2022",

month = sep,

day = "30",

doi = "10.1016/j.sapharm.2022.03.015",

language = "English",

volume = "18",

pages = "3669--3679",

journal = "Research in Social and Administrative Pharmacy",

issn = "1551-7411",

publisher = "Elsevier",

number = "9",

}

TY - JOUR

T1 - Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings

AU - Doherty, Ann Sinéad

AU - Adamson, Gary

AU - Mallett, John

AU - Darcy, Carmel

AU - Friel, Anne

AU - Scott, Michael G.

AU - Miller, EF Ruth

N1 - Funding Information: ASD received funding from Ulster University Vice Chancellor's Research Scholarship. EFRM received funding from the Western Health and Social Care Trust Research Discretionary Fund. The funders had no role in the design of the study, data collection, analysis or interpretation of data, writing of the manuscript nor the decision to submit for publication. Publisher Copyright: © 2022 Elsevier Inc. Copyright © 2022 Elsevier Inc. All rights reserved.

PY - 2022/9/30

Y1 - 2022/9/30

N2 - BACKGROUND: Whilst attention has been paid within the literature to examining potentially inappropriate prescribing (PIP) for older adults in a variety of care settings, less is known about the extent within intermediate care. Furthermore, few studies have examined the utility of clinical pharmacist involvement in this care context.OBJECTIVE(S): Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.METHODS: Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.RESULTS: PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.CONCLUSIONS: Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.

AB - BACKGROUND: Whilst attention has been paid within the literature to examining potentially inappropriate prescribing (PIP) for older adults in a variety of care settings, less is known about the extent within intermediate care. Furthermore, few studies have examined the utility of clinical pharmacist involvement in this care context.OBJECTIVE(S): Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.METHODS: Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.RESULTS: PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.CONCLUSIONS: Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.

KW - Medicines optimisation

KW - Potentially inappropriate prescribing

KW - Pharmacist intervention

KW - Case management

KW - Healthcare utilisation

UR - http://www.scopus.com/inward/record.url?scp=85129832919&partnerID=8YFLogxK

U2 - 10.1016/j.sapharm.2022.03.015

DO - 10.1016/j.sapharm.2022.03.015

M3 - Article

C2 - 35474155

SN - 1551-7411

VL - 18

SP - 3669

EP - 3679

JO - Research in Social and Administrative Pharmacy

JF - Research in Social and Administrative Pharmacy

IS - 9

ER -

Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Fingerprint

Cite this