Pharmacist-led medication reviews for older care home residents: are we delivering person-centred care?
Authors: Lewis R , Tarrant C 
Published: November 2022

Abstract

Introduction
National policy and guidance in England has identified Pharmacists as having a pivotal role in medications optimisation for care home residents with complex polypharmacy. Guidance advocates a person-centred approach to the medication reviews.1 Despite this, studies looking at reviewing and stopping medication rarely include patients’ goals and pReferences regarding medication. There is no consensus regarding a definition for person-centred care or how this translates into practice. Multiple factors may influence the ability of a pharmacist-led care home medication review to include residents’ goals and pReferences, including the pharmacist; local context and resources supporting the review process, and the resident or their family. By exploring these factors, this research study aims to develop a deeper understanding of what person-centred care means in the context of medication reviews in the care home environment, and the barriers and enablers to achieving a person-centred approach.

Aim
This study aims to explore what person-centred care means in the context of pharmacist-led medication reviews for older care home residents, aged 65 years and above and to identify barriers and enablers to achieving a person-centred approach.

Methods
Virtual or telephone, semi-structured qualitative interviews were conducted with pharmacists working in care home roles in England (n=17). Participants were recruited via local and national care home pharmacist networks, and by snowball recruitment. Interviews were anonymised and audio transcribed verbatim before undertaking reflexive thematic analysis2, supported by NVivo software. Ethical approval was obtained from the University of Leicester Medicines and Biological Sciences Research Ethics Committee.

Results
What it means to be person-centred when conducting medication reviews within a care home environment for older residents was seen to be multifactorial, consisting of six key components; 1) focusing on quality of life; 2) understanding what matters to the resident and family regarding medication use; 3) being able to see the resident; 4) showing respect and compassion; 5) considering the resident’s identity, 6) optimising medicines. Four key themes were constructed that shaped the extent to which pharmacists reviews could be person-centred: 1) Trust, acceptance and understanding of the pharmacists’ role; 2) co-ordination and communication regarding care; 3) managing risks, 4) practical barriers.

Discussion/Conclusion
Guidance suggests that structured medication reviews should be person-centred, including the goals and pReferences of the patient and their understanding of medication.1 However, a standard model of how this should be applied to practice does not exist. In order to deliver person-centred care, there needs to be an understanding of what this means in context. By exploring how residents’ goals and pReferences form part of the pharmacist-led care home medication review, this research provides insight into what person-centred care means in context, identifies barriers and enablers to achieving a person-centred approach in the care home environment, and identifies suggestions for practice. This study describes the views of pharmacists and does not include the perspectives of patients or their carers. A further limitation of this research study was that it was undertaken during the pandemic, therefore some participants were only able to reflect on their experiences of virtual reviews.

References
1. Department of Health and Social Care. Good for you, good for us, good for everybody: A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions. Department of Health and Social Care; 2021.
2. Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & Quantity. 2022;56:1391-1412.