Evaluation Of The Quality Of Geriatric Pharmacotherapy Services For Patients With Polypharmacy In Primary Care: A Six-month Observational Study

• By: SATO, Noriko (The University of Sydney, Australia)
• Co-author(s): Dr Noriko Sato (School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  Dr Kenji Fujita (Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia)
  Prof Hiroshi Okada (Department of Social ＆ Community Pharmacy School of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, Japan)
  Dr Kazuki Kushida (Faculty of Pharmacy, Showa Pharmaceutical University, Tokyo, Japan)
  Professor Timothy Chen (School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  
• Abstract:

  Background: Measuring quality of care in primary care is increasingly important for older people with polypharmacy to minimise the harm from medicine use. However, few studies have comprehensively evaluated the quality of geriatric pharmacotherapy services. Therefore, our team has recently developed face and content validated quality indicators (QIs) for medication safety in geriatric pharmacotherapy across 17 disease states in primary care by conducting a modified Delphi study.
  
  Purpose: To evaluate the quality of geriatric pharmacotherapy services provided by community pharmacies in Japan for older patients with polypharmacy.
  
  Method: The face and content validated 130 QIs (109 process indicators and 21 outcome indicators) for geriatric pharmacotherapy was used for six months. Patients were eligible if they were aged 75 years and older with six or more regular medications (i.e., taking more than four weeks). During the study period, participating community pharmacists evaluated 1) how many QIs could be applied to each patient and 2) how many guideline statements described in QIs were adhered to for the patient by their pharmacists at the level of patients. Pharmacists also reported what medicines were the most commonly deprescribed as a result of pharmacists' recommendations using the third level (i.e., pharmacological or therapeutic subgroup) of the Anatomical Therapeutic Chemical classification of the World Health Organisation. All information was reported via the web-based application platform our team had developed for this study. Descriptive statistics were summarised as means with standard deviations, medians with interquartile range (IQR), or percentages.
  
  Results: A total of 60 community pharmacies with 457 patients were enrolled from across Japan. The median age of patient was 82 years (IQR: 79-86) and 56% were females. On average, 16 QIs (IQR: 14-19) needed to be considered for an older patient with polypharmacy. However, only 9 QIs (IQR: 6-12) were actually evaluated by the participating pharmacists, resulting in a guideline adherence rate at the level of patients of 57% (IQR: 40-76%). The total of 112 deprescribing recommendations were accepted by the prescribers. Of the 112, the most frequently deprescribed medicines as a result of pharmacists’ recommendation was drugs for peptic ulcer and gastro-oesophageal reflux disease (A02B, n=12), followed by hypnotics and sedatives (N05C, n=12), and drugs used in benign prostatic hypertrophy (G04C, n=8).
  
  Conclusion: This study found that community pharmacists need to evaluate 16 guideline statements for older patients with polypharmacy. To minimise the risk of adverse drug events, pharmacists may need to prioritise which guideline statements to evaluate. Future studies could investigate the effect of the integration of QIs into an electronic medication record systems on the quality of geriatric pharmacotherapy and the uptake of deprescribing recommendations.