Older people in residential aged care facilities (RACFs) are at risk of medication related harm due to high rates of co-morbidities and inappropriate medication use. There is a need for new models of care using inter-disciplinary collaboration. 

 

This cluster randomised controlled trial (cRCT) was conducted to examine the effectiveness and implementation of employing on-site pharmacists in RACFs. 

 

The cRCT and implementation study was conducted in 20 facilities in the ACT and assessed the effect of having an on-site pharmacists in RACFs on:

• Medication-related outcomes – Potentially Inappropriate Medications (PIM) per Beers criteria (2019), use of psychotropics, poly-pharmacy and Anti-Cholinergic Burden

• Non-medication related outcomes – Emergency Department visits and unplanned hospitalisations, falls, medication incidents and economic cost-effectiveness

• Implementation outcomes – collaboration, normalisation, adherence. 

 

There was a significant reduction in the use of PIM, Anti-Cholinergic Burden scale and a smaller reduction in inappropriate antipsychotic medicines dosage. There were no significant changes in other outcomes. No statistically significant difference was identified between control and intervention group in health care resource usage. Positive working relationships between on-site pharmacists, RACF staff, families and GPs were developed and maintained. 

 

The on-site pharmacist model improved medication management. Employment by the RACF and onsite location facilitated the pharmacist embedding into the RACF team and clinical governance processes. 

 

The Commonwealth Department of Health announced funding for on-site pharmacists in RACFs (2022 Budget), roll out commencing 2023. Findings from our study helped informed this and the training, education, promotion resources and toolkits from this study can be adapted for national scale-up.

 
Jane Koerner1, Sam Kosari2, Mark Naunton2, Rachel Davey1, Ibrahim Haider1, Miranda Batten1, Michael J Dale1
 
 

1.     Health Research Institute, University of Canberra, Canberra, ACT, 2617

2.     Discipline of Pharmacy, Faculty of Health, University of Canberra, Canberra, ACT, 2617