The role of the pharmacist in optimising prescribing in community-dwelling older adults
University College Cork
Background: Providing optimal care for older adults creates many challenges for healthcare providers especially general practitioners. The overarching aim of this thesis was to understand the potential role of the pharmacist in optimising prescribing for older people in primary care. Methods: A cross-sectional study was carried out to highlight the prevalence of prescribing issues in older adults across three European countries. The published literature was then systematically reviewed to evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing (PIP) among community-dwelling older adults. A qualitative study was carried out to reveal the determinants of GP prescribing behaviour for older adults in primary care and to elicit GPs’ views on the potential role for broad intervention strategies involving pharmacists and/or information technology systems in general practice. These findings then informed the pharmacist-led academic detailing intervention with GPs on the topic of urinary incontinence in older people. Results: The cross-sectional study highlighted that PIP and potential prescribing omissions (PPOs) were prevalent in this cohort of European participants. The systematic review demonstrated that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. The qualitative study highlighted the complexities of behavioural determinants of prescribing for older people in primary care and the need for additional supports to optimise prescribing for this growing cohort of patients. One approach that GP participants agreed could lead to a meaningful and sustained improvement in prescribing is interactive educational outreach or academic detailing. Therefore, an intervention was developed incorporating pharmacist-led academic detailing. The results of the research indicate that the intervention was well received and highly valued by GPs. Conclusion: This study has made an important contribution to the topic of prescribing for older adults in primary care by highlighting that educational interventions such as academic detailing are welcomed in the context of general practice in Ireland.
Pharmacist , Prescribing , Older adults , Community-dwelling
O'Riordan, D. 2017. The role of the pharmacist in optimising prescribing in community-dwelling older adults. PhD Thesis, University College Cork.