International Journal of Clinical Pharmacy

, Volume 41, Issue 5, pp 1256–1261 | Cite as

Using telehealth to enable collaboration of pharmacists and geriatricians in residential medication management reviews

  • Leila Shafiee HanjaniEmail author
  • Nancye M. Peel
  • Christopher R. Freeman
  • Leonard C. Gray
Research Article


Background Practical issues impede optimum collaboration between pharmacists and other clinical specialists in the current Australian residential medication review services which potentially affect efficiency, timeliness and quality of outcomes. Objective This mixed methods study aimed to explore the potential value of an existing telehealth platform to enable collaboration of pharmacists and geriatricians in residential medication reviews. Setting Long term care facilities in Australia. Method Twenty vignettes of aged care residents were prepared and independently reviewed by five pharmacists and five geriatricians using a telehealth platform to record their recommendations for medications. The geriatricians were subsequently asked to re-consider their recommendations after being provided with a pharmacist’s report. Main outcome measure The level of agreement between pharmacists and between geriatricians, changes in the mean number of medications after pharmacists’ and geriatricians’ reviews, number of changes in geriatricians’ recommendations after viewing a pharmacist’s report, and pharmacists’ and geriatricians’ feedback. Results Both pharmacists and geriatricians had fair agreement about their recommendations for medications (kappa of 0.30 and 0.31 respectively). The mean number of medications over 20 cases was significantly reduced from a baseline of 14.9 to 13.4 by pharmacists, and to 12.3 by geriatricians after their reviews. There was disagreement between geriatricians and pharmacists on 430/1485 (29%) recommendations on medications; after viewing a pharmacist’s report, geriatricians changed their mind in 51 occasions. Geriatricians found the pharmacist report useful in 72% of the cases. The majority of the pharmacists (4/5) were prepared to use the online system routinely. Conclusion The tested telehealth platform has the potential of being used as a part of routine practice to improve accessibility of the service and to enable synchronous collaboration among healthcare professionals.


Australia Medication review Nursing home Telehealth 



The authors would like to thank the pharmacists and geriatricians who took part in the study. Mr Mark Chatfield (The University of Queensland Centre for Health Services Research) provided statistical help with analysing the level of agreement between pharmacists and geriatricians.


This work was supported by the National Health and Medical Research Council (NHMRC) Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People (Grant No. GNT9100000). Leila Shafiee Hanjani is supported by an Australian Government Research Training Program (RTP). No other sources of funding were used to assist in the preparation of this article.

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1–12.CrossRefGoogle Scholar
  2. 2.
    Jokanovic N, Wang KN, Dooley MJ, Lalic S, Tan EC, Kirkpatrick CM, et al. Prioritizing interventions to manage polypharmacy in Australian aged care facilities. Res Social Adm Pharm. 2017;13(3):564–74.CrossRefGoogle Scholar
  3. 3.
    Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1–9.CrossRefGoogle Scholar
  4. 4.
    Chen TF. Pharmacist-led home medicines review and residential medication management review: the australian model. Drugs Aging. 2016;33(3):199–204.CrossRefGoogle Scholar
  5. 5.
    Pharmaceutical Society of Australia 2017. Guidelines for pharmacists providing Residential Medication Management Review (RMMR) and Quality Use of Medicines (QUM) services.Google Scholar
  6. 6.
    Koria LG, Zaidi TS, Peterson G, Nishtala P, Hannah PJ, Castelino R. Impact of medication reviews on inappropriate prescribing in aged care. Curr Med Res Opin. 2018;34(5):833–8.CrossRefGoogle Scholar
  7. 7.
    McLarin PE, Peterson GM, Curtain CM, Nishtala PS, Hannan PJ, Castelino RL. Impact of residential medication management reviews on anticholinergic burden in aged care residents. Curr Med Res Opin. 2016;32(1):123–31.CrossRefGoogle Scholar
  8. 8.
    Nishtala PS, Hilmer SN, McLachlan AJ, Hannan PJ, Chen TF. Impact of residential medication management reviews on drug burden index in aged-care homes: a retrospective analysis. Drugs Aging. 2009;26(8):677–86.CrossRefGoogle Scholar
  9. 9.
    Nishtala PS, McLachlan AJ, Bell JS, Chen TF. A retrospective study of drug-related problems in Australian aged care homes: medication reviews involving pharmacists and general practitioners. J Eval Clin Pract. 2011;17(1):97–103.CrossRefGoogle Scholar
  10. 10.
    Pouranayatihosseinabad M, Zaidi TS, Peterson G, Nishtala PS, Hannan P, Castelino R. The impact of residential medication management reviews (RMMRs) on medication regimen complexity. Postgrad Med. 2018;130(6):575–9.CrossRefGoogle Scholar
  11. 11.
    Gheewala PA, Peterson GM, Curtain CM, Nishtala PS, Hannan PJ, Castelino RL. Impact of the pharmacist medication review services on drug-related problems and potentially inappropriate prescribing of renally cleared medications in residents of aged care facilities. Drugs Aging. 2014;31(11):825–35.CrossRefGoogle Scholar
  12. 12.
    Department of Health 2017. 2016–17 Report on the Operation of the Aged Care Act 1997.Google Scholar
  13. 13.
    Department of Health and Ageing 2010. Evaluation of the Residential Medication Management Review Program.Google Scholar
  14. 14.
    Australian Institute of Health and Welfare. GEN fact sheet 2017–18: People using aged care. In: Welfare AIoHa, editor. Canberra2019.Google Scholar
  15. 15.
    Poudel A, Nissen LM. Telepharmacy: a pharmacist’s perspective on the clinical benefits and challenges. Integr Pharm Res Pract. 2016;5:75–82.CrossRefGoogle Scholar
  16. 16.
    Reeve E, Bell JS, Hilmer SN. Barriers to optimising prescribing and deprescribing in older adults with dementia: a narrative review. Curr Clin Pharmacol. 2015;10(3):168–77.CrossRefGoogle Scholar
  17. 17.
    Freeman CR, Peel NM, Watts JN, Gaee-Atefi TA, Caffery LJ, Hubbard RE, et al. Development of a protocol for telehealth residential medication management reviews to enable collaboration of pharmacists and geriatricians. J Pharm Pract Res. 2017;47(2):153–7.CrossRefGoogle Scholar
  18. 18.
    Poudel A, Peel NM, Mitchell CA, Gray LC, Nissen LM, Hubbard RE. Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities. Clin Interv Aging. 2015;10:1043–51.CrossRefGoogle Scholar
  19. 19.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefGoogle Scholar
  20. 20.
    Zermansky AG, Alldred DP, Petty DR, Raynor DK, Freemantle N, Eastaugh J, et al. Clinical medication review by a pharmacist of elderly people living in care homes—randomised controlled trial. Age Ageing. 2006;35(6):586–91.CrossRefGoogle Scholar
  21. 21.
    Gustafsson M, Sjolander M, Pfister B, Jonsson J, Schneede J, Lovheim H. Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial. Eur J Clin Pharmacol. 2017;73(7):827–35.CrossRefGoogle Scholar
  22. 22.
    Verrue C, Mehuys E, Boussery K, Adriaens E, Remon JP, Petrovic M. A pharmacist-conducted medication review in nursing home residents: impact on the appropriateness of prescribing. Acta Clin Belg. 2012;67(6):423–9.PubMedGoogle Scholar
  23. 23.
    Crotty M, Halbert J, Rowett D, Giles L, Birks R, Williams H, et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing. 2004;33(6):612–7.CrossRefGoogle Scholar
  24. 24.
    Jokanovic N, Tan EC, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication review in Australia: a systematic review. Res Social Adm Pharm. 2016;12(3):384–418.CrossRefGoogle Scholar
  25. 25.
    Thiruchelvam K, Hasan SS, Wong PS, Kairuz T. Residential aged care medication review to improve the quality of medication use: a systematic review. J Am Med Dir Assoc. 2017;18(1):87.e1–14.CrossRefGoogle Scholar
  26. 26.
    Shafiee Hanjani L, Long D, Peel NM, Peeters G, Freeman CR, Hubbard RE. Interventions to optimise prescribing in older people with dementia: a systematic review. Drugs Aging. 2019;36(3):247–67.CrossRefGoogle Scholar
  27. 27.
    Furniss L, Burns A, Craig SKL, Scobie S, Cooke J, Faragher B. Effects of a pharmacist’s medication review in nursing homes. Randomised controlled trial. Br J Psychiatry. 2000;176:563–7.CrossRefGoogle Scholar
  28. 28.
    de Almeida Neto AC, Chen TF. When pharmacotherapeutic recommendations may lead to the reverse effect on physician decision-making. Pharm World Sci. 2008;30(1):3–8.CrossRefGoogle Scholar
  29. 29.
    Gray L, Wootton R. Comprehensive geriatric assessment ‘online’. Australas J Ageing. 2008;27(4):205–8.CrossRefGoogle Scholar
  30. 30.
    Martin-Khan MG, Edwards H, Wootton R, Counsell SR, Varghese P, Lim WK, et al. Reliability of an Online geriatric assessment procedure using the interRAI acute care assessment system. J Am Geriatr Soc. 2017;65(9):2029–36.CrossRefGoogle Scholar
  31. 31.
    McDerby N, Naunton M, Shield A, Bail K, Kosari S. Feasibility of Integrating residential care pharmacists into aged care homes to improve quality use of medicines: study protocol for a non-randomised controlled pilot trial. Int J Environ Res Public Health. 2018;15(3):499.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Centre for Health Services Research, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
  2. 2.Centre for Optimising Pharmacy Practice-based Excellence in Research, School of PharmacyThe University of QueenslandBrisbaneAustralia

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