1. The integration of pharmacist independent prescribers in long-term care homes can improve drug burden among admitted residents.
2. Long term care homes using pharmacist independent prescribers did not change fall risk compared to general practice.
Evidence Rating Level: 1 (Excellent)
There is an ongoing need to improve prescribing processes in long-term care facilities internationally. As many drug errors continue to occur in care homes, studies have demonstrated that it may be beneficial for an individual to assume central responsibility for medication management. There is currently a paucity of evidence supporting this. Pharmacist independent prescribers (PIPs) can identify pharmaceutical needs of patients and monitor medications without any secondary authorization. Care homes in England, Scotland, and Ireland were included in this study if they provided care to adults over the age of 65 and had a general practice without receiving regular, drug-focused review services. Care homes were randomized to the intervention group which received PIP support and the control group which received general practice care. The recruited PIPs visited care homes to perform medication reviews and optimize drug therapies for the existing residents, while also providing general support in ordering and administering medications. The primary outcome of this study to assess patient safety was care home fall records. Secondary outcomes included the drug burden index, quality of life, and general function. The results of this study suggest that the fall risk was similar amongst the intervention and control group (RR 0.91, 95%CI 0.66-1.26). No major adverse events or safety concerns were identified. Additionally, this intervention decreased prescribing of anticholinergic and sedative medications which may be harmful to older adults and demonstrated significantly improved drug burden index in the intervention group. In conclusion, this large and rigorously conducted randomized controlled trial confirms that integration of PIPs into long-term care homes may enhance effectiveness of medication prescribing. However, the study’s primary outcome of fall risk may not be an adequate measure of effective prescribing. Future randomized controlled trials exploring other outcomes can be helpful in determining true PIP utility.
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