Pharmacy support for older patients improves outcomes, new study finds

Publication of results from CPF project demonstrates value of pharmacy in making real differences to older patients’ quality of life.

Community pharmacies are able to make significant improvements to medicines adherence and quality of life for older patients who are taking multiple medicines, leading to reductions in falls and better medicines optimisation, a new study shows.

The full results from the Community Pharmacy Future (CPF) project’s Four or More Medicines (FOMM) Support Service have been published in the peer-reviewed International Journal of Pharmacy Practice. The results show that the service improved medication adherence among patients aged over 65 years old who were taking four or more medicines regularly. 25 pharmacies in Wigan recruited 620 patients for the FOMM service.

Patients registered for the service had a median of three clinical conditions and were taking a median seven (range five to nine) medicines. The most common conditions were cardiovascular, chronic pain, musculoskeletal and coronary heart disease.

As part of the service, pharmacists reviewed patients’ medication using a subset of STOPP/START* criteria. Pharmacists made 142 recommendations to prescribers in relation to 110 patients, largely centred on potentially inappropriate prescribing of non-steroidal anti-inflammatory drugs, proton pump inhibitors or duplications of therapy. Eight of the recommendations were to start medication (either for asthma or bisphosphonates).

FOMM Support Service: STOPP/START recommendations
Recommendation Number
STOPP - inappropriately high dose 5
STOPP - inappropriate duration of treatment 70
STOPP - potential cautions or side-effects 33
STOPP - potential duplication of therapy 25
STOPP - other issues 1
START - potentially appropriate treatment missing 8
Total 142

After six months of follow-up there was a significant reduction in the total number of medical and self-treated falls experienced by patients and significant increases in medicines adherence (7% improvement on Morisky score) and patient quality of life (measured using EQ-5D). Adherence improved progressively over the course of the evaluation period, with a higher proportion of patients classified as highly adherent at the end of the study. Pharmacists addressed practical issues for patients, some of which had arisen from misalignments in their complex medicines schedules.

Patients were assessed to gauge their risk from falls, especially those related to clinical conditions and medicines use. Where appropriate, pharmacists made recommendations to prescribers for changes in medication that might reduce risks. Patients were also given practical advice on changes they could make at home to reduce risks as well as dietary and lifestyle advice. As a result of these discussions, pharmacists picked up on a range of issues being faced by patients, not all of which were medicines related.

Patients received personal record booklets to record details of their medication. They were encouraged to measure their pain scores and were able to discuss pain management with their pharmacist.

During their regular assessments in the pharmacy, patients were offered information to support healthy lifestyles, including advice on weight, smoking and alcohol use.
Speaking on behalf of the CPF project team, Clare Kerr, Head of Healthcare Policy and Strategy, Celesio UK, and a member of the CPF Management Committee, said: “Our work has shown that delivering targeted and tailored support for patients when they visit a pharmacy brings real benefits. Improvements in clinical outcome measures translated in to tangible benefits that patients and pharmacists noticed. By reducing falls, pharmacists both saved the NHS money and improved patients’ confidence in what they were able to do.
“There were also clear benefits for the NHS itself, with patients being supported to use their medicines in an optimal way. We have also demonstrated that this service can be delivered by pharmacies in a wide range of settings.
“We are very pleased that our CPF work has resulted in this robust addition to the evidence base supporting the commissioning of services from community pharmacies.”


Notes to editors
About the CPF Project

* STOPP – Screening Tool of Older People’s potentially inappropriate Prescribing
   START – Screening Tool to Alert doctor to Right (appropriate, indicated) Treatments

The CPF project, including its initial implementation is being jointly funded by the four largest pharmacy companies – Boots UK, LloydsPharmacy, Rowlands Pharmacy, and Well – as a way of supporting the development of the community pharmacy contractual framework. The services have been designed in full consultation with the Department of Health, PSNC, NHS Employers, local NHS, national clinical directors and GP representatives.

The extension of the services to additional pharmacies has been supported by the PSNC, which has provided funding to cover some of the cost of implementation of the services.

Local support for the project is being provided by Bruce Prentice of Ashton, Wigan & Leigh LPC.

The research has been published in IJPP:

The CPF COPD Support Service (along with an associated COPD Case Finding Service) – conducted in parallel to the FOMM Support Service – won the Respiratory Medicine Team of the Year category in the BMJ Awards 2014 on 8 May. The overall CPF project was shortlisted for the Pharmaceutical Care Award 2014.
For further information please contact:
Boots UK Press Office
0115 959 5995

The Community Pharmacy Future project is a collaboration between
Well Pharmacies
Lloyds Pharmacy
Rowlands Pharmacy a company of the PHOENIX group