Medicines optimisation for frail older people in primary care

: An exploration of community pharmacists' experiences, knowledge and perspectives

Abstract

The aim of this thesis was to identify the current evidence base for medicines optimisation interventions for frail older patients in primary care, and to explore the role of community pharmacists in optimising medicines use for frail older people using a mixed-methods approach. A systematic review was conducted to identify medicines optimisation interventions for community-dwelling frail older patients. Community pharmacists’ knowledge of frailty, experiences with frail older patients, and perspectives of frailty and medicines optimisation were explored through semi-structured interviews(n=15), followed by a questionnaire distributed to all registered community pharmacy premises in Northern Ireland (n=528). Comparative analyses were conducted for a sub-set of questionnaire items included in a questionnaire administered to Canadian pharmacists. Finally, an educational resource package for community pharmacists about frailty was developed and evaluated. The systematic review identified a lack of medicines optimisation interventions delivered to frail older patients in primary care; only one study met the inclusion criteria for this review. However, this study did highlight the potential role that community pharmacists could play in delivering interventions to this patient population. Interviews conducted with community pharmacists identified that community pharmacists lacked knowledge about frailty. This finding was also supported by data from questionnaire respondents and similar gaps in knowledge were observed with Canadian community pharmacists. Positive feedback was obtained regarding the educational resource. The research presented in this thesis has identified a lack of high-quality evidence for medicines optimisation interventions for frail older people in primary care. Whilst community pharmacists are ideally placed to deliver such interventions, gaps in their knowledge about frailty must be addressed. Further research is therefore needed to address these knowledged eficits and to develop and evaluate medicines optimisation interventions. The views of other relevant key stakeholders, including frail older patients, their family members, and carers, should also inform future work.

Thesis is embargoed until 31 December 2025.

Date of Award	Dec 2022
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Department for the Economy
Supervisor	Heather Barry (Supervisor) & Carmel Hughes (Supervisor)