New study reveals opportunity for greater partnerships to improve medicines use for people with dementia
Published this week, results of a large-scale audit of a two year service pilot reveal the positive role specially trained pharmacists can play in collaboration with GPs, nurses and care home workers in better managing the appropriate use of antipsychotic medicines for people with dementia in care homes.
According to the study, through the use of specially trained pharmacists in a pilot service, over one quarter (26%) of residents reviewed did not have any symptoms which necessitated a regular anti-psychotic medication, and in almost two thirds (58%) of cases the risk of the medication was deemed to outweigh the benefit. In addition, the audit resulted in over 20% of residents having their anti-psychotic dose reduced, and more than 17% realising antipsychotic medication discontinuation. The audit was undertaken by selected Boots UK pharmacists, some of whom had received additional Alzheimer’s Society training to enable them to better support people with dementia and carers.
Alistair Burns, National Clinical Director for Dementia at NHS England comments:
“The prescribing of antipsychotic drugs in people with dementia is associated with increased mortality and morbidity. This exciting publication underscores the key role that pharmacists have in optimising prescription of medication in this potentially vulnerable population.”
The study was commissioned by Boots UK in order to demonstrate the potential added value that community pharmacy can offer, and the significant contribution this service could make to the NHS. The pilot service demonstrates how the commissioning of pharmacy services could help further improve the care of vulnerable patients who live in residential care homes, working in partnership with other healthcare professionals. Since this audit was undertaken, the government has launched the G8 Dementia Challenge and is currently updating the National Dementia Strategy which aims to deliver major improvements in dementia care by 2015.
Dr James Pickett, Head of Research at Alzheimer’s Society comments, “Alzheimer’s Society has long campaigned for alternatives to antipsychotic medications as they are potentially harmful and can worsen the symptoms of dementia. This audit highlights the important role that community pharmacists can play in making sure these alternatives are considered. We’ve seen a 50 per cent reduction in the prescription of anti-psychotics to people with dementia in recent years and, in light of this new evidence, we hope this trend will continue.”
The community pharmacy-led service audit evaluated the use of antipsychotic medicines across 463 UK care homes over a two year period. Community pharmacists, including those specially trained by Alzheimer’s Society, worked alongside the healthcare professionals responsible for people with dementia within care homes to create an action plan for the use of antipsychotic medication in line with NICE guidance. In over 58% of cases the risk of antipsychotic medicines was deemed to outweigh the benefit of the prescription.
David Wright, Professor of Pharmacy Practice at the University of East Anglia and one of the study authors comments, “Reducing the use of antipsychotic drugs for people with dementia is a government priority, and this audit has shown that collaborative working between pharmacists, GPs, nurses and care home staff is a key way of addressing this objective. Pharmacy is an underused resource within the NHS and this latest research demonstrates a valuable role community pharmacists can play in improving patient care.”
Results highlight role community pharmacy can play in medicines optimisation for residents with dementia in care homes
Asif Aziz, Director of Care Services, Boots UK adds: “Better medicines optimisation has been identified as a key way to supporting patients more effectively and we know that it can make a real difference to patient’s lives – especially those living with long term conditions. This pilot demonstrates how, if commissioned at a national or local level, pharmacy could play a crucial role in supporting patients to get the most from their medicines – whether that is via one of our stores or through one of our many dispensing services within the community.”
The clinical audit of antipsychotic medicines was carried out by Boots UK from July 2010 to June 2012 as result of their partnership with the care home leadership teams who had expressed a need for support in better managing the medicines of their service users. Anti-psychotic prescribing was identified as a priority area.
National guidance from the National Institute of Health and Care Excellence (NICE), states that only people with particular types of dementia, such as vascular, may be prescribed antipsychotic medicines (in the correct circumstances), due to the risk of severe adverse reactions.ii During the audit, community pharmacists worked with care professionals responsible for people with dementia within care homes to create an action plan for the use of antipsychotic medication in line with NICE guidance.
Read more here
Dementia Supporting people with dementia and their carers in health and social care, available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200030/9535-TSO-2900951PM_Challenge_Dementia_ACCESSIBLE.PDF