Qualitative analysis of community pharmacists’ opinions on their involvement in reducing potentially inappropriate prescribing
- 176 Downloads
Older people are at risk of potentially inappropriate prescribing (PIP) due to polypharmacy arising from multi-morbidity. Despite available explicit criteria to reduce PIP, it is highly prevalent. Whilst community pharmacists have the required knowledge to help reduce PIP, they are not currently engaged with the problem. This study explores the views of community pharmacists on their potential involvement in reducing PIP and determines the challenges to its implementation.
Semi-structured interviews with pharmacists working in community pharmacies in Ireland. The theoretical domains framework (TDF) was used to develop the topic guide and to analyse the transcripts. Domains of highest relevance for PIP reduction were identified based on their frequency or whether the participants emphasised the impact of constructs within a domain. Local ethical approval was obtained.
Of 18 participants, 12 were female, median age was 30 years (IQR, 27–35) with a median of 6 years (IQR, 3–8) of experience. Seven TDF domains were identified as relevant to PIP reduction. Pharmacists were uncertain about their role in reducing PIP and reluctant to challenge physicians’ prescribing decisions. Challenges pertained to the environment, knowledge, social influences, professional role and identity.
Pharmacists welcomed new responsibilities in reducing PIP as part of their daily practice but expressed a need for removal of social and environmental barriers as well as, provision of relevant guidelines and education about PIP. This study provides useful insights into the target domains for overcoming barriers of pharmacist involvement in reducing PIP.
KeywordsPharmacist Primary care Older patients Prescribing Qualitative
The authors would like to acknowledge all pharmacists who took part in this study for their time and interest in the study.
Compliance with ethical standards
Ethical approval for this study was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals prior to recruitment. Written informed consent was obtained from all participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Moriarty F, Bennett K, Fahey T, Kenny RA, Cahir C (2015) Longitudinal prevalence of potentially inappropriate medicines and potential prescribing omissions in a cohort of community-dwelling older people. Eur J Clin Pharmacol 71:473–482. https://doi.org/10.1007/s00228-015-1815-1 CrossRefGoogle Scholar
- 7.van der Stelt CA, Vermeulen Windsant-van den Tweel AM, Egberts AC (2016) The association between potentially inappropriate prescribing and medication-related hospital admissions in older patients: a nested case control study. Drug Saf 39:79–87. https://doi.org/10.1007/s40264-015-0361-1 CrossRefGoogle Scholar
- 9.Moriarty F, Bennett K, Cahir C, Kenny RA, Fahey T (2016) Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study. Br J Clin Pharmacol 82(3):849–857. https://doi.org/10.1111/bcp.12995 CrossRefGoogle Scholar
- 10.Bradley MC, Fahey T, Cahir C, Bennett K, O'Reilly D, Parsons C, Hughes CM (2012) Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland enhanced prescribing database. Eur J Clin Pharmacol 68(10):1425–1433. https://doi.org/10.1007/s00228-012-1249-y CrossRefGoogle Scholar
- 11.Castillo-Paramo A, Claveria A, Verdejo Gonzalez A, Rey Gomez-Serranillos I, Fernandez-Merino MC, Figueiras A (2014) Inappropriate prescribing according to the STOPP/START criteria in older people from a primary care setting. Eur J Gen Pract 20(4):281–289. https://doi.org/10.3109/13814788.2014.899349 CrossRefGoogle Scholar
- 12.O'Connor MN, O'Sullivan D, Gallagher PF, Eustace J, Byrne S, O'Mahony D (2016) Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older Persons’ prescriptions and screening tool to alert to right treatment criteria: a cluster randomized controlled trial. J Am Geriatr Soc 64(8):1558–1566. https://doi.org/10.1111/jgs.14312 CrossRefGoogle Scholar
- 13.Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 157:1531–1536. https://doi.org/10.1001/archinte.1997.00440350031003 CrossRefGoogle Scholar
- 14.Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151(9):1825–1832. https://doi.org/10.1001/archinte.1991.00400090107019 CrossRefGoogle Scholar
- 15.Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163(22):2716–2724. https://doi.org/10.1001/archinte.163.22.2716 CrossRefGoogle Scholar
- 18.Dalleur O, Boland B, Losseau C, Henrard S, Wouters D, Speybroeck N, Degryse JM, Spinewine A (2014) Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: a randomised controlled study. Drugs Aging 31(4):291–298. https://doi.org/10.1007/s40266-014-0157-5 CrossRefGoogle Scholar
- 19.Frankenthal D, Lerman Y, Kalendaryev E, Lerman Y (2014) Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc 62(9):1658–1665 1658p. https://doi.org/10.1111/jgs.12993 CrossRefGoogle Scholar
- 22.Milos V, Rekman E, Bondesson A, Eriksson T, Jakobsson U, Westerlund T, Midlov P (2013) Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study. Drugs Aging 30(4):235–246. https://doi.org/10.1007/s40266-013-0057-0 CrossRefGoogle Scholar
- 27.Keller ME, Kelling SE, Cornelius DC, Oni HA, Bright DR (2015) Enhancing practice efficiency and patient care by sharing electronic health records. American Health Information Management Association. http://perspectives.ahima.org/enhancing-practice-efficiency-and-patient-care-by-sharing-electronic-health-records/. Accessed 20 February 2018
- 28.Duncan EM, Francis JJ, Johnston M, Davey P, Maxwell S, McKay GA, McLay J, Ross S, Ryan C, Webb DJ, Bond C (2012) Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implement Sci 7:86. https://doi.org/10.1186/1748-5908-7-86 CrossRefGoogle Scholar
- 32.McKenzie JE, French SD, O'Connor DA, Grimshaw JM, Mortimer D, Michie S, Francis J, Spike N, Schattner P, Kent PM, Buchbinder R, Green SE (2008) IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): cluster randomised controlled trial study protocol. Implement Sci 3(1):11. https://doi.org/10.1186/1748-5908-3-11 CrossRefGoogle Scholar
- 35.Cardwell K, Hughes CM, Ryan C (2018) Community pharmacists’ views of using a screening tool to structure medicines use reviews for older people: findings from qualitative interviews. Int J Clin Pharm. https://doi.org/10.1007/s11096-018-0659-z
- 36.Rodondi N, Trelle S, Spinewine A (2015) OPERAM: optimising therapy to prevent avoidable hospital admissions in the multimorbid elderly. http://operam-2020.eu/. Accessed 04 December 2016
- 37.O’Mahony D, Byrne S, Postea O (2015) SENATOR: software engine for the assessment and optimization of drug and non-drug therapy in older persosns. University College Cork. http://www.senator-project.eu/home/. Accessed 02 December 2016
- 38.Deprivation - Pobal HP Deprivation Indices. Pobal - Government Supporting Communities. https://maps.pobal.ie/. Accessed 03 May 2017
- 40.Farrell B, Black CD, Thompson W, McCarthy L, Rojas-Fernandez C, Lochnan H, Shamji S, Welch V, Bouchard M, Upshur R (2017) Deprescribing antihyperglycemic agents in older persons: evidence-based clinical practice guideline for deprescribing antihyperglycemics. Can Fam Physician 63(11):832–843Google Scholar
- 41.Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman Wilms L, Rojas-Fernandez C, Sinha S, Thompson W, Welch V, Wiens A (2018) Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia. Can Fam Physician 64(1):17–27Google Scholar
- 42.Pottie K, Thompson W, Davies S, Grenier J, Sadowski C, Welch V, Holbrook A, Boyd CM, Swenson JR, Ma A, Farrell B (2018) Deprescribing benzodiazepine receptor agonists. Can Fam Physician 64(5):339–351Google Scholar
- 43.Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ (2017) Deprescribing proton pump inhibitors. Evidence-based clinical practice guidelines. Can Fam Physician 63(5):354–364Google Scholar
- 44.Green J, Thorogood N (2014) In-depth interviews. In: Seaman J (ed) Qualitative Methods for Health Research, 3rd edn. SAGE, Great Britain, pp 95–125Google Scholar
- 47.National Institute for Health and Care Excellence (2017) Clinical guidelines. NICE guidelines. https://www.nice.org.uk/guidance. Accessed Feb 20 2018
- 51.Reeve E, Farrell B, Thompson W, Herrmann N, Sketris I, Magin P, Chenoweth L, Gorman M, Quirke L, Bethune G, Forbes F, Hilmer S (2018) Evidence-based clinical practice guideline for deprescribing cholinesterase inhibitors and memantine. The University of Sydney, SydneyGoogle Scholar