Marle Gemmeke, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
Ellen Koster, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
Nathalie van der Velde, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Katja Taxis, Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
Marcel Bouvy, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
ABSTRACT
Background information
Community pharmacists are in the position to contribute to fall prevention, but this is not yet common practice.
Purpose
The aim of this study was to evaluate the implementation of a community pharmacy-based fall prevention service.
Method
A fall prevention service, consisting of a fall risk screening and assessment including a medication review, was implemented in pharmacies during three months. A preparative online training was provided to the pharmacy team to enhance adoption of the service. Included patients were aged ≥ 70 years, using ≥ 5 drugs of which ≥ 1 fall risk-increasing drug. The implementation process was quantitively assessed by registering medication adaptations, recommendations, and referrals to other health care providers. Changes in patient scores on the Short Fall Efficacy Scale-International (FES-I) and a fall prevention knowledge test were documented at one month follow-up. Implementation was qualitatively evaluated by conducting semi-structured interviews with pharmacists before and after the project, based on the consolidated framework of implementation research (CIFR). Interviews were conducted with patients one month after they participated in a community pharmacy fall prevention service. Topics of these interviews were: outcomes, patient’s motivation, and contact with the pharmacy technician, which were based on the CFIR.
Results
The service was implemented in nine pharmacies and 91 consultations were performed. Medication was adapted of 32 patients. Patients’ FES-I scores were significantly higher at follow-up (p = 0.047) and patients’ knowledge test scores did not differ (p = 0.86). Pharmacists experienced the following barriers: lack of time, absence of staff, and limited multidisciplinary collaboration. Facilitators were training, motivated staff, patient engagement, and project scheduling. Patients were mainly positive about receiving a medication review. Although patients reported that the service enhanced their awareness about fall prevention, only a limited number of patients was motivated to adapt their lifestyle. Patients appreciated the attention and contact.
Conclusion
The service resulted in a substantial number of medication adaptations and lifestyle recommendations, but many barriers were identified that hamper the sustained implementation of the service. Patients see a potential benefit from a medication review by their pharmacist and patient education appeared to enhance their fall risk awareness. Topic area:Implementation research