Quality of prescribing in UK care homes : using local data to recommend optimal prescribing strategies
Author(s)
Loganathan, Mathumalar
Type
Thesis
Abstract
Background:
Inappropriate prescribing (IP) for older people is a public health concern worldwide because
of its implications for increased healthcare costs and adverse drug events (ADE). Care home
residents are particularly prone to IP due to intrinsic (frailty) and extrinsic (governance and
management of homes) factors. My PhD focussed on prescribing for this vulnerable
population. Methods:
I conducted two systematic reviews which were aimed at: 1) establishing an IP-ADE link;
and 2) interpreting interventions employed to reduce IP. Additionally, I evaluated the
effectiveness of a multidisciplinary intervention in reducing IP in two nursing homes
(combined sample size of 143 residents) managed by one general practice. In this
multidisciplinary intervention, feedback from both a pharmacist medication review and an
audit using STOPP (Screening Tool of Older Person's Prescriptions) which identified
potentially inappropriate medication (PIM) and START (Screening Tool to Alert doctors to
Right Treatment) which identified potential prescribing omission (PPO) were utilised by two
general practitioners (GPs) to make appropriate changes to prescriptions. I compared the pre
and post-intervention scores for PIMs and PPOs. Finally, I provided recommendations to
improve overall prescribing quality in UK care homes.
Main findings:
The findings include: 1) Evidence for a correlation between IP and ADE was weak; 2)
Interventions involving academic detailing, pharmacist medication review and
multidisciplinary team meetings were more successful; 3) After the 13 months study, residents in the post-intervention group were significantly less likely to have been prescribed
a PIM (RR 0.52, 95% CI 0.41-0.67) or a PPO (RR 0.58, 95% CI 0.48-0.69) as compared to
residents in the pre-group. Factors influencing the number of PIMs and PPOs were number of
medications and number of comorbidities respectively; 4) Recommendations for improving
prescribing quality were broadly categorised into five areas: future research; legislation and
directives; education and training; integrated healthcare services; and information technology.
Conclusion:
The multidisciplinary pharmacist-GP-researcher intervention is an effective and practical
approach to reducing IP for nursing home residents.
Inappropriate prescribing (IP) for older people is a public health concern worldwide because
of its implications for increased healthcare costs and adverse drug events (ADE). Care home
residents are particularly prone to IP due to intrinsic (frailty) and extrinsic (governance and
management of homes) factors. My PhD focussed on prescribing for this vulnerable
population. Methods:
I conducted two systematic reviews which were aimed at: 1) establishing an IP-ADE link;
and 2) interpreting interventions employed to reduce IP. Additionally, I evaluated the
effectiveness of a multidisciplinary intervention in reducing IP in two nursing homes
(combined sample size of 143 residents) managed by one general practice. In this
multidisciplinary intervention, feedback from both a pharmacist medication review and an
audit using STOPP (Screening Tool of Older Person's Prescriptions) which identified
potentially inappropriate medication (PIM) and START (Screening Tool to Alert doctors to
Right Treatment) which identified potential prescribing omission (PPO) were utilised by two
general practitioners (GPs) to make appropriate changes to prescriptions. I compared the pre
and post-intervention scores for PIMs and PPOs. Finally, I provided recommendations to
improve overall prescribing quality in UK care homes.
Main findings:
The findings include: 1) Evidence for a correlation between IP and ADE was weak; 2)
Interventions involving academic detailing, pharmacist medication review and
multidisciplinary team meetings were more successful; 3) After the 13 months study, residents in the post-intervention group were significantly less likely to have been prescribed
a PIM (RR 0.52, 95% CI 0.41-0.67) or a PPO (RR 0.58, 95% CI 0.48-0.69) as compared to
residents in the pre-group. Factors influencing the number of PIMs and PPOs were number of
medications and number of comorbidities respectively; 4) Recommendations for improving
prescribing quality were broadly categorised into five areas: future research; legislation and
directives; education and training; integrated healthcare services; and information technology.
Conclusion:
The multidisciplinary pharmacist-GP-researcher intervention is an effective and practical
approach to reducing IP for nursing home residents.
Date Issued
2012-02
Date Awarded
2012-07
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Bottle, Alex
Franklin, Bryony Dean
Majeed, Azeem
Sponsor
Malaysia ; Universiti Teknologi MARA
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)