In line with the requirements for the PCN direct enhanced specification 2022/2023, all care home residents received a structured medication review from a clinical pharmacist, who is an independent prescriber and has completed the primary care training pathway.
The aim of this case series was to explore the impact of a clinical pharmacist SMR on anticholinergic burden and hyperpolypharmacy, defined for this as ten or more medicines.
The sample for the case series consisted of twenty five consecutive new residents moving into a residential care home in inner west Newcastle PCN between April 2021 and March 2022, no exclusion criteria were applied. The sample consisted of eight male, and seventeen female residents with an average age of eighty-seven years. Each resident received an SMR for a clinical pharmacist.
Data were collected for age, sex, anticholinergic burden score before and after SMR, and number of medicines before and after SMR. Data was analysed using SPSSv13 where a valid statistical test existed. Results showed that a clinical pharmacist SMR statistically significantly reduced anticholinergic burden and hyperpolypharmacy in the sample of new admissions to a residential care home.
Using a Wilcoxon signed-tank test, average ACB score was statistically significantly reduced from 1.9 before SMR to 1.1 after SMR. No significant differences were observed between male and female residents. Number of medicines were significantly reduced from an average of 7.48 before SMR to 5.88 after SMR, and statistical significance was observed using a paired-samples t-test.
From the observed de-prescribing trends, overactive bladder medications were associated with significant ACB increasing the risk of falls and adverse effects. North East and Cumbria are the highest prescribers of laxatives to care home residents and future work should explore the correlation between laxative use and admissions to secondary care due to bowel obstruction.
Over-prescribing of antihypertensives, antidepressants, antipsychotics, and diuretics for dependent oedema were other significant trends in de-prescribing noted, reducing potential harm, falls risk and adverse events.
Future work will consider the impact of clinical pharmacist SMR on patient-related outcomes such as reducing falls, improving quality of life and function. Larger samples from multiple centres randomised to intervention or control and followed up for longer may be necessary to establish adverse outcomes and to investigate the impact of factors such as gender or co-morbidity on SMR outcome.
