Use this URL to cite or link to this record in EThOS:
Title: An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland.
Author: Patterson, Susan Mary
ISNI:       0000 0001 3477 8142
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2009
Availability of Full Text:
Access from EThOS:
Introduction: This study adapted and tested the implementation of a holistic United States (US) pharmaceutical care model in nursing homes in Northern Ireland (NI). Methods: A qualitative study involving healthcare professionals and resident advocates was conducted to inform the adaptation of the US model to suit the NI primary care environment. The adapted model was tested in a cluster randomised controlled trial (cRCT) conducted in nursing homes over 12 months. The primary outcomes were the change in the number of residents prescribed inappropriate psychoactive (anxiolytic, hypnotic or anti-psychotic) medicines and the number of falls. An economic evaluation was carried out to calculate the change in direct healthcare resource usage over time. Economic modelling, including multidimensional work sampling, was performed to estimate the costs of service provision. Results: From the qualitative study findings, the main adaptations required in the UK related to pharmacists' access to medical records, prescribers and nursing home residents. In the cRCT, 11 matched pairs of nursing homes and 334 residents participated. Overall 51% residents (n=171) were taking an inappropriate psychoactive mcdication (0.74/ rcsident). At baseline thcrc was no difference in the proportion taking inappropriate psychoactive medications in the intervention (92/173, 53%) and control groups (79/161, 49%). At 12 months there was a significant rcduetion (p<0.001) in the proportion taking inappropriate psychoactive medications in the intervention group (25/128,20%) compared to controls (62/124, 50%), corresponding to an odds ratio (95% confidence intervals) of 0.26 (0.14, 0.49), aiter adjustment for clustering within homes. No differences were observed at 12 months between the number of residents with one or more falls or the falls rate. Healthcare costs remained unchanged over time. Economic modelling estimated a service provision cost of £80.25 per resident/annum. Healthcare professionals thought that pharmaceutical care should forn1 part of the normal range ofprimary care serVices. Conclusion: These findings highlight that pharmaceutical care significantly improves the quality of psychoactive prescribing in UK nursing homes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available