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Care of older people

Community pharmacists could bridge gap of care for older housebound patients, study shows

Researchers conclude that no single service can maintain patient independence, therefore strong collaborative working across local stakeholders is in the interest of patient wellbeing.

Nearly 40% of isolated, housebound patients have a variety of difficulties taking their medicines, including a lack of dexterity or difficulty swallowing, according to a study published in Research in Social and Administrative Pharmacy.

However, the research authors have said that home visits from pharmacists may be able to help identify the care needs of this patient group and link them with other parts of the care pathway.

According to the authors, an increasing number of housebound patients ”are not seen by the pharmacists responsible for the provision” of their medicines and instead are dependent on carers, who ”may not have the necessary skills nor time” for medicine support.

As a result, they set out to evaluate the impact of pharmacist-led holistic domiciliary medicine use reviews (dMURs) in housebound patients based in the London Borough of Richmond.

Between May 2015 and January 2016, 12 community pharmacists visited a total of 133 housebound patients and carried out a structured dMUR and an assessment of each patient’s living conditions. The patients had a mean age of 81.7 and took an average of 9.4 different medicines.

On average, each patient was taking three medicines that were classed as “high risk” and associated with a higher chance of hospital admission, such as warfarin, opiates and antidepressants.

Some 39% of the patients had physical difficulties taking their medicines, including a lack of dexterity in opening a blister pack; applying eye drops; and difficulty swallowing. Over 26% of 30 diabetic patients lacked monitoring; while 14% of patients overall were identified as being as risk of falling.

In addition, 17% of the patients had recently run out of a medicine, and over 28% said they were concerned about taking one or more of their medicines, particularly if they were taking more than ten.

Patients were also found to be experiencing “continence, dehydration, hygiene and nutrition issues… often caused by mobility problems or a lack of suitable toilet facilities,” the report said.

The authors said that the study highlighted the difficulties faced by housebound patients, including social care needs, safety hazard and inadequate hydration and nutrition.

They suggested that pharmacists could provide a link in the care pathway to help integrate many aspects of care for this patient group by understanding their medicines and care needs in the context of their home environment.

“No single service can maintain patient independence alone, therefore the establishment of relationships with all local stakeholders — including pharmacists — to promote collaborative working is in the interest of the wellbeing of patients,” the study concluded.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206384

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