Reforming the quality use of medicines in Australian aged care facilities: a new pharmacy practice model

摘要

Objective Numerous problems exist with accessing prescription medicines in Australian Residential Aged Care Facilities (RACF). This research aimed to identify the issues surrounding a theoretical model for pharmacists' prescribing in these facilities that had been proposed to address these problems. Specific objectives were to conceptually tailor the model to the RACF setting and qualitatively examine its potential applicability. Setting Data were collected from June to September 2004 via 34 semi-structured interviews with representatives of 28 stakeholder organisations, and 12 homogeneous focus groups comprising 25 consumers, 28 pharmacists and 18 medical practitioners representing rural and metropolitan locations. Participants were sourced from four states/territories of Australia. Method The so-called 'Medication Maintenance' model had previously been developed from the international literature and discussion with an expert steering committee. It proposes a system for pharmacists to continue Pharmaceutical Benefits Scheme prescriptions for patients whose therapy had been stabilised by a medical practitioner, by one month, one repeat or one original pack, as appropriate. The potential benefits, harms, barriers and facilitators were discussed with relevant stakeholders. Data were thematically analysed, and recommendations made for trial of the model. Key findings Potential benefits of the 'Medication Maintenance' model include improved patient focus, efficiency and interprofessional relationships. Potential harms include increased risk, possible wastage and exploitation. Potential barriers include role conflict, lack of controls, legislative issues and conflict of interest for pharmacists. Facilitators for the model were identified as defined roles and protocols, limitations on supply, regular patient review, communication channels and shared patient records. Conclusion A range of benefits, harms, barriers and facilitators of this theoretical model were elucidated from stakeholders. This has led tothe proposal of a staged implementation trial of the model, which should involve clinical, humanistic and economic outcome monitoring, and attitudi-nal, practical and legislative issues to be addressed.