Objective The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes. Setting The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists. Method We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998–2005). Main outcome measures The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002. Results In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs. Conclusion The pharmaceutical care service was fully and successfully implemented in Fribourg’s nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Landefeld CS, Palmer R, Johnson MA, Johnston B, Lyons W. Current geriatric: diagnosis and treatment. New York: Lange Medical Books/McGraw-Hill; 2004. ISBN 0-07-139924-0.
Höpflinger F, Hugentobler V. Soins familiaux, ambulatoires et stationnaires des personnes âgées en Suisse—Observations et perspectives [Family, ambulatory and medical care for Swiss elderly patients—observations and perspectives]. Chêne-Bourg: Médecine et Hygiène; 2006. ISBN 2-88049-216-5.
Guignard E, Bugnon O. Pharmaceutical care in community pharmacies: practice and research in Switzerland. Ann Pharmacother. 2006;40:512–7. doi:10.1345/aph.1G199.
Carmichael JM, Beth M, Devine B, Kelly W, Ereshefsky L, Linn W, et al. Collaborative drug therapy management by pharmacists. Pharmacotherapy. 1997;16:1050–61.
Ruggli M, Buchmann M, Bugnon O. Pharmaceutical Services in Institutions for the Elderly: A Concrete Example for Community Pharmacists. In: Charlie Benrimoj editor. Proceedings of the 62nd world congress of pharmacy and pharmaceutical sciences, Community Pharmacy Section; 2002 September 4–5; Nice, France. 2002. p. 27–42.
Ruggli M, Buchmann M, Burgy I, Bugnon O. Action plan for the dissemination of a new pharmaceutical service in institutions for the elderly. In: Proceedings of the 63rd world congress of pharmacy and pharmaceutical sciences, Community Pharmacy Section. 2003 September 8–9; Sydney, Australia; 2003.
Fribourg health law. Loi du 16 novembre 1999 sur la santé [Legal update on health law—16 november 1999]. http://appl.fr.ch/sleg_bdlf/Result.aspx. Accessed 10 July 2008.
Fribourg health law. Loi du 28 novembre 2000 concernant les produits thérapeutiques [Law on therapeutic products—28 november 2000]. http://www.fr.ch/v_ofl_bdlf_courant/fra/8212021.pdf. Accessed 10 July 2008.
Fribourg health law. Ordonnance du 17 décembre 2002 approuvant la convention santésuisse et AFIPA ainsi que ses annexes I et II sur les soins dispensés dans les EMS fribourgeois [Agreement 2002 santésuisse-AFIPA (including appendices I and II) on health care provided in the Fribourg nursing homes]. http://admin.fr.ch/fr/data/pdf/publ/rof_2003/2003_021_f.pdf. Accessed 10 July 2008.
Swiss Association of Pharmacists. Dispositions générales et programme de formation complémentaire FPH en Assistance pharmaceutique d’établissements médico-sociaux (EMS) [Standard of practice and postgraduate training FPH in pharmaceutical care assistance service in nursing homes]. http://www.pharmasuisse.org/de/media/mehrsprachig/fahigkeitsprogramme/heime/frz/02_Faehigkeitsprogramm_HEIME_Anhang_I_d_frz.pdf. Accessed 10 July 2008.
Health department of the canton of Fribourg. Cahier des charges du pharmacien-conseil de l’établissement [Content specification for the pharmacist working in a nursing home]. http://appl.fr.ch/ssp/formulaires/cahier_des_charges_du_pharmacien-conseil_version_definitive_aout_2007.pdf. Accessed 10 July 2008.
Holland RW, Nimmo CM. Transitions in pharmacy practice, part 3: effecting change—the three-ring circus. Am J Health Syst Pharm. 1999;56:2235–41.
van Mil F. Barriers or facilitators? Pharm World Sci. 2005;27:69. doi:10.1007/s11096-005-3344-y.
Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm. 2005;1:546–64. doi:10.1016/j.sapharm.2005.09.003.
Chow GC. Tests of equality between sets of coefficients in two linear regressions. Econometrica. 1960;28:591–605. doi:10.2307/1910133.
Christensen DB, Farris KB. Pharmaceutical care in community pharmacies: practice and research in the US. Ann Pharmacother. 2006;40:1400–6. doi:10.1345/aph.1G545.
Eickhoff C, Schulz M. Pharmaceutical care in community pharmacies: practice and research in Germany. Ann Pharmacother. 2006;40:729–35. doi:10.1345/aph.1G458.
Jones EJ, Mackinnon NJ, Tsuyuki RT. Pharmaceutical care in community pharmacies: practice and research in Canada. Ann Pharmacother. 2005;39:1527–33. doi:10.1345/aph.1E456.
Ballard CG, Margallo-Lana ML. The relationship between antipsychotic treatment and quality of life for patients with dementia living in residential and nursing home care facilities. J Clin Psychiatry. 2004;65(Suppl 11):23–8.
Gill SS, Bronskill SE, Normand SL, Anderson GM, Sykora K, Lam K, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146:775–86.
Gobert M, D’hoore W. Prevalence of psychotropic drug use in nursing homes for the aged in Quebec and in the French-speaking area of Switzerland. Int J Geriatr Psychiatry. 2005;20:712–21. doi:10.1002/gps.1349.
Kasckow JW, Mulchahey JJ, Mohamed S. The use of novel antipsychotics in the older patient with neurodegenerative disorders in the long-term care setting. J Am Med Dir Assoc. 2004;5:242–8.
Rochon PA, Stukel TA, Bronskill SE, Gomes T, Sykora K, Wodchis WP, et al. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med. 2007;167:676–83. doi:10.1001/archinte.167.7.676.
Schneeweiss S, Setoguchi S, Brookhart A, Dormuth C, Wang PS. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ. 2007;27(176):627–32.
Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294:1934–43. doi:10.1001/jama.294.15.1934.
Locca JF, Favre M, Du Pasquier S, Zumbach S. Bugnon. Treatment safety in elderly patients with behavioral and psychological symptoms of dementia (BPSD): a retrospective analysis in nursing homes. World Congress of Pharmacy and Pharmaceutical Sciences—66th Congress of International Pharmaceutical Federation. Cairo: 2006.
Locca JF, Zumbach S, Bula C, Bugnon O. Du delirium au syndrome démentiel: prise en charge médicamenteuse dans les EMS fribourgeois. Rev Med Suisse. 2007;3:2519–29. Management of elderly patients with delirium or dementia in Swiss nursing homes.
Locca JF, Bula C, Zumbach S, Bugnon O. Pharmacological treatment of behavioral and psychological symptoms (BPSD) in nursing homes: development of practice recommendations in a Swiss Canton. JAMDA. 2008;9:439–48. doi:10.1016/j.jamda.2008.04.003.
We sincerely thank the directors, nurses and physicians of the Fribourg nursing homes, the AFIPA, the Fribourg Insurers Association (santésuisse Fribourg), the participating pharmacists, the Fribourg Pharmacists Association and the Swiss Association of Pharmacists for their active roles.
None to declare.
Conflicts of interest
None to declare.
Rights and permissions
About this article
Cite this article
Locca, JF., Ruggli, M., Buchmann, M. et al. Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton. Pharm World Sci 31, 165–173 (2009). https://doi.org/10.1007/s11096-008-9273-9
- Economic impact
- Nursing homes
- Pharmaceutical care service