A systematic review of quantitative studies exploring staff views on antipsychotic use in residents with dementia in care homes.

BACKGROUND: Despite significant warnings of adverse effects, antipsychotics continue to be prescribed for managing the behavioural and psychological symptoms of dementia (BPSD) in care homes. Information provided by staff working within care homes is a factor that can influence prescribing decisions in residents with BPSD. AIM: The review aimed to capture care home staff views towards antipsychotics for residents with BPSD and separately analyse tools utilized in the studies, mapping them onto the theory of planned behaviour (TPB). METHOD: A comprehensive literature search published in ten databases was conducted between May and July 2020 and updated in July 2021. Studies published in full with no date restriction were included and quality assessed using CROSS checklist. A thematic framework approach was applied to extract data and study tools which were then mapped onto the TPB. RESULTS: Fourteen studies (2059 participants) were included. Findings identified four overarching themes: attitudes toward antipsychotics (e.g. antipsychotics as an appropriate strategy and effectiveness); barriers to deprescribing (e.g. lower staff education, lack of resources and time, poor medication reviews); measures implemented (e.g. nonpharmacological interventions, medication reviews); and perceived needs of staff (e.g. need for training, financial or clinical support). Identified tools addressed seven but not all components of TPB namely, behavioural, normative and control beliefs, attitude, perceived behavioural control, intention and behaviour. CONCLUSION: The positive attitudes toward antipsychotics, the identified barriers to deprescribing and the existing tools not addressing all components of the TPB provide the impetus for further research.

Patient views about polypharmacy medication review clinics run by clinical pharmacists in GP practices.

Background Polypharmacy can decrease medication adherence and increase the incidence of adverse drug reactions and drug-drug interactions, resulting in falls, hospitalisations and other complications especially in the elderly. Medication-related problems of polypharmacy can be prevented through patient-centred medication reviews but research in this area has been completed largely without examining patients' viewpoints. Objective The aim was to investigate patient views about a clinical pharmacist-led patient-centred polypharmacy medication review service completed within 17 English GP practices with those ≥ 75 years of age and prescribed ≥ 15 medications, during 415 consultations. Method A patient feedback questionnaire was constructed and face validated with two pharmacists then posted by a Clinical Commissioning Group pharmacist to all patients who had taken part in the service. Data from returned questionnaires were analysed using descriptive statistics and qualitative patient comments were analysed using thematic analysis. Results Of the 166 patients (40% response rate) who returned a feedback questionnaire 83% found the service helpful. Medication-related concerns of 94% who had a concern beforehand were addressed, and 80% understood their medicines better after the review. Patients appreciated pharmacists' personal approach, advice and explanation. Conclusion Patients expressed broadly positive views about polypharmacy reviews by clinical pharmacists within GP practices.

Supporting the management of type 2 diabetes with pharmacist-led reviews: an observational analysis.

OBJECTIVE: Describe and assess the impact of a pharmacist-led patient review programme on the management and control of type 2 diabetes (T2D). DESIGN: Uncontrolled prospective cohort study with before and after intervention data collection. SETTING: General practices within NHS Slough Clinical Commissioning Group (CCG). PARTICIPANTS: 5910 patients with T2D. INTERVENTIONS: Pharmacists reviewed 5910 patients and worked with general practice teams to schedule any of the 9 key care processes recommended by the National Institute for Health and Care Excellence (NICE) that the patients were lacking, to optimise medication and to make other interventions such as providing lifestyle advice. MAIN OUTCOME MEASURES: The proportion of patients receiving the NICE-recommended 9 key care processes and proportion of patients whose glycated haemoglobin (HbA1c), blood pressure (BP) or total cholesterol (TC) readings were over target before and after the intervention period. RESULTS: The proportion of patients receiving all of the NICE-recommended 9 key care processes increased from 46% at project outset in April 2013 to 58% on completion in April 2014 and the percentage of patients achieving HbA1c, BP and TC targets all increased (65% to 70%, 70% to 76%, 78% to 82%, respectively). Quality Outcomes Framework (QOF) data for Slough CCG showed the percentage of diabetic patients achieving target HbA1c, BP and TC readings increased from April 2013 to April 2014, but then diminished in the year after project completion. CONCLUSIONS: The pharmacist-led review increased the number of key care processes administered and improved diabetic control during the year of programme delivery. The improvement abated during the year after, suggesting that such programmes should be ongoing rather than fixed term. The programme combined the strategic drive and project facilitation skills of Slough CCG, the general practice teams' knowledge of their patients and the clinical and information technology skills of an experienced pharmacist team.