Evaluation of a pharmacist-led polypharmacy review project

摘要

There is a rise in multimorbidity within frail and ageing populations, which can lead to a natural increase in polypharmacy. Local and national guidelines, such as National Institute for Health and Care Excellence guidance and Realistic Prescribing Scottish Polypharmacy guidance, recommend that patients at risk of inappropriate polypharmacy should be identified for review. However, owing to low levels of patient engagement in deprived areas and stringent thresholds used to define polypharmacy, a large number of patients may be excluded from pharmacy review. Aim: The Govan Social and Healthcare Integration Partnership (SHIP) project aimed to provide multidisciplinary care to patients in one of the most deprived areas in Glasgow, Scotland, in an attempt to reduce the health inequality gap. Pharmacist polypharmacy reviews were developed to provide pharmaceutical care for patients enrolled in the SHIP project, which included a consultation with a pharmacist independent prescriber to reach a joint informed decision and formulate an individualised pharmaceutical care plan. While the project ran from 2015-2018, pharmacist involvement commenced in January 2018 and ended in August 2018. Method: Patients were referred for pharmacy review by healthcare professionals from four participating general practices in Govan based on the referrer's clinical judgement and not predefined criteria. Desktop medicine reviews were performed for all SHIP patients and appointments were made for polypharmacy reviews based on pharmaceutical needs (n=151). Changes in medicine were discussed between the pharmacist and the patient, after which the GP and the multidisciplinary team (MDT) were informed of the review's outcome — either directly if urgent or at monthly MDT meetings. The project team continuously collected intervention data and gathered feedback from members of the MDT. Results and conclusions: Pharmacist medication reviews were effective, with positive feedback received from patients and members of the MDT. Deprescribing and inhaler counselling were the most common interventions. The team behind the project concluded that this comprehensive method of identifying patients for pharmacy review can be transferred to any location, and should be modified to include further follow up and evaluation.