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Dementia

Pharmacists play a vital role in the care of people with dementia

Alex MacKinnon, director of RPS director Scotland, explains how pharmacists can improve the pharmaceutical care of people with dementia.

The Mental Welfare Commission for Scotland published its report “Dignity and respect: continuing care visits” in June. The report, based on visits to 52 NHS units providing longer-term care for people with dementia and reviewing the care of 336 people and speaking to 129 carers or relatives, made a number of recommendations relevant to pharmacy. These included:

  • People with dementia taking multiple psychotropic medicines should be prioritised for multidisciplinary review, including pharmacy, to ensure the continued use is appropriate;
  • All people with dementia receiving psychotropic medicines should have their continuing need for this reviewed every three months. Where the benefit of a medicine is not clear, it should be gradually withdrawn with appropriate monitoring of target symptoms;
  • Full multidisciplinary reviews should be carried out at least annually; carers should be actively encouraged to participate in these. Pharmacy should be included as a core part of the unit multidisciplinary team.

I strongly welcome this piece of work and whole-heartedly agree with the recommendation regarding the inclusion of pharmacy as a core discipline within the healthcare team. Despite our repeated recommendations for formalised and consistent clinical pharmacy input into the care of people, particularly frail older people and people with dementia, this has clearly not yet been achieved as part of a core service in Scotland. In most cases pharmacists’ involvement is mainly limited to the supply of medicines and there is little clinical input from community pharmacists or pharmacists working in the managed service. 

In Scotland we are somewhat behind the United States where care homes are required to employ an independent consultant pharmacist to undertake regular reviews of antipsychotic medicines, with the aim of reducing or discontinuing unnecessary or inappropriate medication. Currently, within most care homes, nursing and care staff and GPs provide care and manage medicines, with monthly interactions with a community pharmacy to supply the medicines.

I firmly advocate that much better use of pharmacists’ expertise should be enabled in order to maximise patient care and outcomes. Previous studies have demonstrated a reduction in antipsychotic prescribing[1] and a reduction in falls.[2] Most recently, a two-year UK service pilot resulted in over 20% of residents having their antipsychotic dose reduced and more than 17% having their antipsychotic medicines discontinued[3] after a pharmacist-conducted clinical medication review. Therefore, I believe we have strong evidence demonstrating positive patient outcomes.

Our report “Improving pharmaceutical care in care homes” highlighted these issues and, with the evidence presented in the Mental Welfare Commission for Scotland’s report, RPS Scotland continues to call for speedy implementation of our recommendations by the Scottish Government and for NHS Scotland to commit to mandatory input from pharmacists to ensure that the Government’s “Prescription for excellence” ambition of high-quality, safe, effective and person-centred care can be delivered.

Alex MacKinnon is director of RPS director Scotland. 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065579

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