465 Medicines optimisation for residents with dementia during the COVID-19 pandemic: a qualitative study of the views and experiences of care home managers
Authors: Alsulami N , Hughes C M , Barry H E 
Published: April 2023

Abstract

Introduction
The COVID-19 pandemic has disproportionately affected people with dementia, especially those in care homes (1). The pandemic may have exacerbated existing medication challenges that care home residents with dementia may experience, such as issues with adherence and administration.

Aim
To explore the views and experiences of care home managers in Northern Ireland (NI) about optimising medicines use and accessing primary healthcare services for residents with dementia during the COVID-19 pandemic and identify key lessons for supporting care home staff with medicines optimisation for residents with dementia both now and during future health crises.

Methods
Care home managers were recruited using several approaches which utilised purposive and snowball sampling. Participant sampling and recruitment commenced in January 2022 and finished in July 2022. The interview topic guide was developed based on published literature, current COVID-19 guidelines for care homes, and following discussion within the research team; it was piloted with two nurses with experience of working in care homes. Semi-structured interviews were conducted either using an online video-conferencing platform or via the telephone after obtaining written informed consent from participants. All interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis (2). Analysis of data is ongoing.

Results
Fourteen interviews were conducted, lasting between 25 and 56 minutes. Findings to date have highlighted the challenges care homes have faced whilst caring for residents with dementia during the pandemic. Participants described changes to the way in which primary healthcare services were provided. In particular, provision of services from general practice (e.g. prescribing, consultations) were mostly conducted over the telephone and/or online and some participants reported that this had an impact on medication review: ‘’it's only the review of medication that has not been done during the pandemic’’ [CHM_07]. Restrictions on visiting to care homes during the initial and middle phases of the pandemic affected aspects of medicines optimisation for residents with dementia and an already stretched care sector: “There was a lot of problems… prior to COVID. COVID just made those problems monumental’’ [CHM_14]. Most participants perceived that community pharmacy services were not affected by the pandemic and medication supply continued: “We haven’t had an issue with community pharmacy to be honest with you’’ [CHM_03]. Participants identified lessons for future health crises including the need for improved communication with general practitioners, the importance of a multidisciplinary team effort to optimise medicines for residents with dementia, along with input from residents’ family members, and greater support for care homes.

Conclusion
This study has highlighted the difficulties that care home managers have faced in accessing general practice services during the pandemic and the impact this has had on residents with dementia receiving medication review. Whilst these findings add to a limited evidence base, they may not be generalisable to other parts of the UK. Future work will focus on development of a questionnaire study with care home managers.

References
1. Gordon AL, Goodman C, Achterberg W, Barker RO, Burns E, Hanratty B, et al. COVID in care homes – challenges and dilemmas in healthcare delivery. Age Ageing. 2020 Aug 24;49(5): 701-705.
2. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2008 Jul 21;3(2): 77-101.