Pharmcist led intervention to improve medication use in older in-patients living with frailty: the Drug Burden Index

Use of the DBI calculator© may lead to improvements in how medicines are managed in hospital. This would mean less drug costs and drug side effects. Overall, the project may lead to improving the quality of life for older Canadians.

About the Project

With the aging global population and associated increase in polypharmacy internationally, efforts are needed to optimize medication use and reduce exposure to potentially harmful medications through deprescribing. There are numerous barriers to deprescribing such as lack of recognition of potentially harmful medications and limited time of prescribers. Hospitalization provides a unique opportunity to conduct deprescribing activities as there is access to an interdisciplinary team and the ability to conduct short term monitoring in a controlled environment.

Therefore, the objective of this project is to evaluate the implementation of the DBI Calculator© as a tool to enhance pharmacist led medication optimization in hospital. This study aims to explore factors that influence the success of the intervention and its impact on clinical outcomes.

The proposed project will be conducted in hospital wards across Nova Scotia, purposely chosen to represent a variety of different contexts (e.g. urban versus rural, geriatrics versus general medicine). Outcomes of implementation will be compared with a historical, pre-intervention control group. The primary outcome is the prevalence of patients who have a reduction in DBI score during admission. Secondary outcomes include patient relevant clinical outcomes such as falls, cognition and adverse drug reactions. Sub-group analysis will be conducted to determine if there are different effects of the intervention on frail versus robust older adults and male versus female patients. To complement the quantitative methods to determine the effectiveness and outcomes of the intervention, we will conduct a multiple case study analysis to qualitatively explore barriers and facilitators to the intervention (such as frailty and gender).

The results of this study will inform wider implementation of initiatives to optimise medication use in older inpatients across Nova Scotia as well as expansion to other provinces.

Project Team

Principal Investigators:

Emily Reeve, Bpharm(Hons) PhD, Afiliate Scientist, Nova Scotia Health Authority

Kenneth Rockwood, MD FRCPC FRCP, Professor of Medicine, Nova Scotia Health Authority

Jennifer Isenor, BSc(Pharm) PharmD, Assistant Professor, Dalhousie University

Susan Bowles, BScPhm PharmD MSc(CHE), Associate Professor and Clinical Coordinator, Geriatric Medicine and Residency Coordinator, Nova Scotia Health Authority

Co-Investigators:

Sarah Hilmer, BScMed(Hons) MBBS(Hons) FRACP PhD, Professor of Geriatric Pharmacology, University of Sydney

Caroline Sirois, Bpharm MSc(Pharmacy, Hospital) MSc(Pharmacoepidemiology) PhD, Chairholder, Research Chair on Aging (Titulaire de la Chaire de recherche sur le vieillissement), Associate professor (Professeure agrégée), Université Laval

April Negus, BScN MN NP, Specialty Nurse Practitioner, Nova Scotia Health Authority

Kent Toombs, RPh BSc(Pharm) ACPR, Director of Pharmacy, Northern Zone, Nova Scotia Health Authority

Olga Kits, BA(Hons) MA(Medical Sociology) PhD(candidate), Health Research Methodologist (Qualitative), Research Methods Unit, Nova Scotia Health Authority

Mohammad Hajizadeh, BSC MSC PhD, Assistant Professor, Dalhousie University

Colin VanZoost, MD FRCPC, Internal Medicine Site Chief, Dartmouth General Hospital, Nova Scotia Health Authority

Heather Neville, BScPharm MSc, Drug Utilization Pharmacist and Pharmacy Research Coordinator, Nova Scotia Health Authority

Lisa Kouladjian, BMedSC(Hons) Mpharm PhD AACPA, Research Assistant, University of Sydney

Marilyn Peers, CM MSW LLD, Community Representative, Nova Scotia Health Authority

Project Contact: Emily Reeve — emily.reeve@sydney.edu.au

CAT2017-13

Keywords: Frail Elderly; Polypharmacy; Drug-Related Side Adverse Reactions; Inpatients; Cognitive Dysfunction; Cholinergic Antagonists; Hypnotics and Sedatives; Pharmacists; Deprescribing; Geriatrics