Are pharmacists of value as independent prescribers in long-term care facilities?

A new randomized controlled trial has assessed the clinical effectiveness and safety of U.K. pharmacists as independent prescribers providing pharmaceutical care within long-term care facilities (care homes) compared with usual care. U.K. pharmacists are allowed to prescribe independently, but no study to date has assessed the effectiveness of pharmacist independent prescribers in care homes. The study involved care homes across England, Scotland and Northern Ireland, including a total of 876 residents randomly allocated to the intervention group (n=449) or the control group (n=427). Each pharmacist independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits (~ 4 hours/week) over six months. Prior to the study, pharmacist independent prescribers received specific training for their role over a six-week period. The training program involved training on managing medicines for older people with complex needs. After the training period, pharmacist independent prescribers were assessed by a general practitioner and a pharmacist mentor, to ensure their competency. In the intervention group, pharmacist independent prescribers developed a pharmaceutical care plan for each resident, performed medication reviews/reconciliation, optimized drug therapy, trained staff on medication-related issues, and supported medication-related procedures, including deprescribing and prescribing. Participants in the control group received usual general practitioner-led care. The primary outcome was fall-rate/person at six months. Secondary outcomes included quality of life (by EQ-5D-5L score), physical functioning (by Barthel score), Drug Burden Index (a measure of anticholinergic and sedative drug exposure), hospital admissions and mortality. Results showed the following: One-third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. The intervention group had 697 falls (1.55 per resident) compared to 538 falls (1.26 per resident) in the control group at six months (a nonsignificant difference after adjustment for covariates). Secondary outcomes were also not significantly different between the two groups, with the exception of the Drug Burden Index, which significantly favoured the intervention group. The Drug Burden Index improved from 0.72 to 0.66 in the intervention group, and worsened in the control group from 0.70 to 0.73; the ratio of Drug Burden Index scores at six months between intervention and control groups was 0.83 (0.74 to 0.92; p

Are pharmacists of value as independent prescribers in long-term care facilities?

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